Over the years, I have had the privilege of working in various capacities, including as a clinician, president of several societies and a consultant. I have been actively involved in numerous initiatives aimed at expanding access to Ambulatory Surgery, improving safety standards, and promoting best practices globally. My journey with the IAAS began several years ago when I started as a representative of the US-based Ambulatory Surgery Center Association to IAAS’ General Assembly. I also participated in its conferences. I am humbled and honoured to serve in this capacity and I am excited to continue working towards the global expansion and improvement of Ambulatory Surgery during my term.

During my term as president of the IAAS, my primary objectives will center around four key areas:

• A. Global Expansion and Accessibility: I aim to increase the global reach of Ambulatory Surgery by promoting its benefits and supporting the establishment of Ambulatory Surgery centers in regions where they are not yet prevalent. This includes working closely with our member associations and their local healthcare providers, governments, and organizations to develop tailored strategies that address specific regional needs and challenges. For countries that already have established Ambulatory Surgery practices, aim to help them fine-tune their practices and prepare for the continued expansion of ambulatory surgery as guided by evidence-based results;
• B. Safety and Quality Improvement: Ensuring the highest standards of safety and quality in Ambulatory Surgery is a top priority. I plan to focus on enhancing our existing guidelines and developing new protocols that can be adapted to different healthcare settings as represented by our member associations. We will also continue to provide education and training opportunities to healthcare professionals to maintain and improve these standards through benchmarking relevant patient outcomes;
• C. Technological Integration and Innovation: Embracing and integrating new technologies is essential for the continued advancement of Ambulatory Surgery. My goal is to facilitate the adoption of better communication venues among our members wherever possible as well as digital health tools. By doing so, we can improve patient outcomes and increase efficiency;
• D. Reinforcing the Infrastructure of the Association: These objectives will help guide our members’ efforts as we work to make Ambulatory Surgery more accessible, safer and more effective for patients globally.

The IAAS will promote and expand Ambulatory Surgery through educational outreach and training programs, collaboration with local healthcare systems, advocacy and awareness campaigns, resource sharing and knowledge exchange among the members, supporting infrastructure development, and tailored regional conferences and events.

IAAS promotes safety and quality in Ambualtory Surgery by having tailored strategies for regional needs assessment and customization. IAAS recognizes that each region has unique healthcare needs, cultural factors and regulatory environments. Therefore, capacity building and training programs are a must. Educational training will expand our educational offerings to include more region-specific training programs. Partnering with local stakeholders and having collaborative efforts will forge partnerships with local governments, healthcare institutions and professional associations to advocate for the inclusion of ambulatory surgery within national healthcare frameworks. Educating local governments on the safety and advantages of ambulatory surgery is an absolute must.

I would like to create a quality committee within the association to promote best practices and quality standards. The IAAS promotes global standards for safety, quality and efficiency in Ambulatory Surgery. We will share best practices from regions with advanced ambulatory surgery systems and help implement these practices in emerging markets. This will ensure that as ambulatory surgery expands, it does so with a focus on patient safety and high-quality care. Monitoring and evaluating continuous improvement is an essential component of any patient quality initiative, and I would aim to have the association help set those benchmarks.

Yes, the IAAS is actively planning to collaborate with other international health organizations. We recognize that partnership and collaboration are essential for advancing the field of Ambulatory Surgery on a global scale. It will be key to have joint initiative and projects through collaborative programs that will advance Ambulatory Surgery at a local level and one efficient way to do that is to partner with local associations, as well as region specific organizations. It is also key to emphasize harmonization of standards and guidelines in order to help global consistency and ways to measure it. Through education and training, collaborating with the international health organizations will allow us to extend our reach and provide training and capacity-building programs. One recent example of such is our efforts to help regulations in Peru.

This is a broad topic that we could spend hours discussing. Ambulatory Surgery has made significant strides over the years, but it also faces several challenges that need to be addressed to ensure its continued growth and success. Top issues include patient selection and safety since the complexity of cases has grown tremendously over time.

Also, infrastructure and resources can be limited in many regions and there is a lack of dedicated Ambulatory Surgery centers equipped with the necessary infrastructure to perform a wide range of procedures safely. Building and maintaining these facilities requires significant investment, and this can be a barrier to the expansion of ambulatory surgery, particularly in low resource settings.

Regulatory and policy barriers are also a significant hurdle in developing and expanding Ambulatory Surgery. The regulatory environment for ambulatory surgery can vary widely from one region to another. In some areas, there are restrictive regulations that limit the types of procedures that can be performed in an ambulatory setting, or there may be a lack of clear guidelines altogether. Navigating these regulatory challenges is crucial for the growth of ambulatory surgery.

Financial and insurance challenges can also be a major hurdle for the advancement of Ambulatory Surgery. Insurance coverage and reimbursement policies can be inconsistent and create financial challenges for both providers and patients In some cases, ambulatory surgery may not be adequately covered by insurance, leading to higher out of pocket costs for patients and financial losses for providers.

Finally, cultural and perception barriers can lead to hurdles for patients and provider acceptance. In some regions, there is a cultural preference for inpatient care, with both patients and healthcare providers being hesitant to embrace Ambulatory Surgery.

Technological innovations are set to significantly shape the future of Ambulatory Surgery, enhancing both safety and efficiency of procedures while improving patient outcomes. Minimally invasive surgical techniques and advances in laparoscopy, endoscopy and robotic-assisted surgery will be at the forefront all surgical domains. Enhanced anesthesia and pain management with long acting analgesics and pain-control devices will also play a crucial role. Telemedicine and remote monitoring are fast evolving fields which will, for sure, change the degree to which patients having ambulatory surgery will be assessed preoperatively and monitored after discharge. Last but not least, Artificial Intelligence and Machine Learning will have a crucial role in improving diagnostics, patient selection and surgical planning.

To foster the growth of ambulatory surgery globally, public health policies need to support the development of infrastructure, ensure equitable access to care and promote best practices in safety and quality. Some of the key public health policies that could favor the expansion of ambulatory surgery include:

Ambulatory Surgery has a very bright future. We have proven equal or better outcomes as compared to inpatient surgery, financial advantages and great patient satisfaction. It would be very hard to argue against the success that ambulatory surgery has had for decades.

One notable example of a country that has successfully implemented an Ambulatory Surgery model is the United States, particularly through the proliferation of Ambulatory Surgical Centers (ASCs). These facilities have become a significant part of the U.S. healthcare landscape, offering a range of procedures that can be performed on an outpatient basis.

Innovation and Flexibility: ASCs often have more flexibility to adopt new technologies and procedures compared to larger hospitals. This adaptability can lead to innovative approaches in surgical care and patient management.

The advice that I would have for a young professional wishing to pursue a career in Ambulatory Surgery would be to, first, focus on education and training and hands on experience. Seek opportunities for internships, residencies, or job placements in Ambulatory Surgery centers or outpatient clinics. It is also important to develop a patient-centered approach focusing heavily on patient care and satisfaction. A deep understanding of infection control protocols and patient safety measures is critical. It is also important to gain knowledge of healthcare management, business acumen and regulatory knowledge. Understanding the business of healthcare, including cost-management, billing and insurance processes can be very advantageous. Also be aware of the regulatory landscape including accreditation standards and compliance requirements for surgery centers. It would be great to find a mentor to connect with an experienced professional in the field who can provide guidance, support and valuable insights.

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