Quality Indicators in Ambulatory Surgery: A Literature Review Comparing Portuguese and International Systems

João Silva Nunes, Rebeca Gomes, Ana Povo, Eurico Castro Alves


Introduction: According to several studies conducted in North America and Europe, ambulatory surgery is a practice that has grown over the years, and both the number of more complex surgical procedures deemed suitable for ambulatory surgery and the number of patients with different co-morbidities which are now suitable for this type of procedure have been increasing. In order to respond to the increased number of day surgeries, as well as to avoid a potential proportional increase in perioperative morbidity, quality control systems must be adopted to enable continuous improvement and minimise predicted risks. The purpose of this study is to review global quality indicators used in ambulatory surgery and compare them with those used in Portugal.

Material and Methods: The authors conducted a comprehensive search of medical databases, using MeSH words. Limits were applied to include only studies published after 1998 written in Portuguese, English and Spanish. Ambulatory surgery indicators for Portugal were also obtained.

Results: Twenty-one different quality indicators for ambulatory surgery were identified. The Portuguese Healthcare Regulation Authority has defined seven quality indicators for ambulatory surgery.

Discussion: The Portuguese quality indicators for ambulatory surgery are generally well adapted to current international practices. Nevertheless, after analysing the relevant international literature based on this study, it is important to consider two additional indicators for ambulatory surgery – same day surgery cancellations and patient satisfaction.

Conclusion: On the literature review, same day surgery cancellations and patient satisfaction should be included in the National Health Assessment System created by the Portuguese Healthcare Regulation Authority.


Ambulatory Surgical Procedures; Outcome Assessment (Health Care); Portugal; Quality of Health Care; Quality Indicators, Health Care

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