J. of Ambulatory Surgery 12 (2005) 85–87 Review Recent developments in ambulatory surgery in Portugal Paulo Lemos 1 Department of Anaesthesiology, Hospital Geral de Santo Ant´ onio, 4099-001 Porto, Portugal Received 4 May 2005; accepted 19 May 2005 Available online 18 July 2005 Day surgery has greatly increased all over the world since the 90’s. Nevertheless, many European countries such as Portugal have not kept pace with this development in the surgical field. Having an almost completely free national health service (NHS) easily accessed by society, Portugal presents similar demographic data (percentage of popula- tion older than 65-year-old), health clinical indicators (infant mortality rate, life expectancy) or human resources (physi- cian ratio) to the most developed countries of the world [1]—Table 1. However, costs within the health service have increased greatly in the last few years, making Portugal the fourth highest spender of its gross domestic production health in the European Community after Germany, France and Greece. The hospital network is composed of 82 public surgical hospitals and 92 smaller private hospitals. Since 2001, there has been a change in the management of public hospitals. These hospitals have been divided into two main groups. One is called the SPA group (Public Administration Sector group) and is a continuity of the previous system. It includes 50 hos- pitals and the majority of the Portuguese University Hospitals (except Hospital Geral Santo Ant´ onio, at Porto). The other group is named the SA group (Anonymous Society group) and includes 32 hospitals. The SA hospitals, although not for- mally based on a profit enterprise management, were created with the intention of being more rational from an economic point of view and more effective in cost containment. After 3 years of experience, it seems that the SA hospital group has become more efficient and effective with lower costs than the same hospitals in the group in previous years [2]. However, a quality analysis has not yet been done and further studies should be performed in order to investigate the results of this Portuguese experience. E-mail address: paulo.f.lemos@netcabo.pt. 1 President of the Portuguese Association of Ambulatory Surgery— APCA. The last National Survey on ambulatory surgery (AS) [3], showed that 46,111 major surgeries were performed on a day surgery basis, that is, 14.6% of a total of 315,642 non-emergency surgeries. This represents a doubling of day surgery performed in the last 2 years and a three-fold increase in the period of 4 years, from 1999 till 2003—Table 2. Look- ing back to our last report on the Portuguese evolution of AS [4], this is an extraordinary increase especially because the major difficulties for the development of AS are still present. We still have a restrictive non-competitive legislation and financing of day surgery, where day procedures have a mean financing value between 50 and 60% of the same procedure performed as an inpatient. Moreover, there is a lack of Health Policy towards the promotion of day surgery, in spite of an increased waiting surgical list and increased health costs in the last couple of years. The author stresses the fact that only major surgery was considered. Minor surgery performed with local anaesthe- sia without the presence of an anaesthesiologist, was not included in the data presented in Table 2, and this represented in 2003, 127,073 surgeries. If we had included minor surgery in our data we would have performed 173,184 surgeries on a day basis, representing 39.1% of a total of 442,715 non- emergency surgeries. This is a critical point when analysing data from national surveys as in the majority of cases all types of surgeries are included. Minor surgery can represent, as much as 40% of all non-emergency surgery introducing bias in national reports where there is no distinction between minor and major surgical cases. In the 2001 National Survey very few hospitals had more than 30% of non-emergency surgery performed on a day surgery basis [5]. The 2003 National Survey showed that 12 Portuguese hospitals undertook more than 30% and 18 hospitals between 15 and 30% of non-emergency surgery, respectively, on a day basis. Almost 70% of all hospitals included (in a number of 80) had an AS programme running in their hospitals. 0966-6532/$ – see front matter © 2005 Published by Elsevier B.V. doi:10.1016/j.ambsur.2005.05.001