Scientific Subcommittee 2 – Ambulatory Anaesthesia

Scientific Subcommittee 2 – Ambulatory Anaesthesia

  • Issue 72

Mark Skues, Chair, Scientific Subcommittee 2

mskues@gmail.com

The Scientific Subcommittees of the ESA can be thought of as the ‘life blood’ of the Association, as they provide the insight and preparation that guarantees the success of the Annual Euroanaesthesia meetings. Without these committees being constituted and run, there would be no annual congress that provides scientific and educational updates for all members. Indeed, even the President has stated that the Scientific Committee is ‘at the heart of the Society’.

There are currently sixteen subcommittees in operation, where the chairs are established experts in their particular fields of delivery that cover all facets of anaesthesia. Chairs are appointed for a three-year tenure, with an additional 18-month period to allow continuity of handover, by a competitive submission of curricula vitae and subsequent appointment. Desirable characteristics of putative chairpersons are a background within their field of expertise, a publication record that matches their insight, knowledge of the current developments and controversies within their field, and both experience with the delivery of educational material and the ability to chair such sessions.

The primary role of the chairs is to organise and submit suggestions for possible presentations at Euroanaesthesia scheduled twelve to eighteen months in the future. These can take the form of lectures, debates, symposia, or workshops, for which up to 240 minutes may be allocated. The Subcommittee on Intensive Care Medicine may allocate up to 480 minutes of didactic material. To aid the development process, each chair has a subcommittee of up to 3 additional members who are similarly appointed for three years by competitive application, to assist the chair in their deliberations. A meeting is then convened in Brussels in the spring, where all proposals are considered and either accepted or rejected for the following year’s meeting.

Another component of Euroanaesthesia is the review and acceptance of abstracts. This is a role that is delegated to members of each subcommittee, who score every submission using a fixed template, from which suitable abstracts are accepted for presentation. This can be an extremely onerous workload, given the number of abstracts submitted, with, on average, approximately 50 abstracts requiring review. After marking, chairs for each abstract session are selected from the names of faculty members attending the forthcoming Euroanaesthesia, and the abstracts are allocated by the Chair of the relevant subcommittee to relevant individuals to lead the sessions.

Having reviewed the role and constitution of the Scientific Subcommittees, it is appropriate to move on and review forthcoming presentations for June 2018, when Euroanaesthesia will be held in Copenhagen, Denmark. One symposium that has been potentially ‘pencilled in’ from the Subcommittee for Ambulatory Anaesthesia aims to review the outcomes of Ambulatory Surgery in various European countries.

We know that the performance of successful surgery on a day case basis is dependent on the facilitation of an elective pathway that begins with referral to the Primary Care Practitioner, followed by the outpatient appointment, decision to operate, pre-operative assessment, operation and discharge on the day, and post-operative follow up. All of these components are dependent on close co-operation and teamwork between anaesthetist, surgeon, and nursing teams. The ongoing success of collaboration has been seen in England, together with the alteration of funding mechanisms that financially incentivise procedures such as laparoscopic cholecystectomy, allowing the procedure to be successfully managed as a day case procedure. Current rates for laparoscopic cholecystectomy in 2015 indicate that 53% are carried out as a day case in England,1 with the procedure earning an additional €300 compared with an inpatient procedure. Comparable information for various European countries reported for 20142 would seem to indicate varying degrees of success in provision of patients as day cases (Table 1).

 

The wide variation in European rates does not seem to be limited to laparoscopic cholecystectomy, as review of rates for inguinal hernia repair and partial excision of mammary gland (wide local excision) would seem to indicate similar findings (Table 2), with the Nordic countries being seemingly more successful than the others listed.

The proposed symposium aims to evaluate the variation between rates for ambulatory surgery across Europe, seeking to identify the reasons why such differences exist. High on the list would seem to be the differences in funding mechanisms, with England now incentivised for a total of 33 operative procedures suitable for day surgery that seems to have been a significant driver for improvements in rates of ambulatory surgery.

References

  1. Skues M. BADS Directory of Procedures. National Dataset. Calendar Year 2015. London: British Association of Day Surgery, 2015.
  2. Leroy R, Camberlin C, Lefèvre M, et al. Proposals for a further expansion of day surgery in Belgium. Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE). 2017. KCE Reports 282. D/2017/10.273/09.