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Moving Forward

Glass, Peter S. A., MBChB, FFA(SA)*; Gan, Tong J., MBBS, MD, MHS, FRCA

doi: 10.1213/ANE.0b013e3182246de1
Editorials: Editorials

From the *Department of Anesthesia, Stony Brook Medical Center, Stony Brook, New York; and Department of Anesthesiology, Duke North Hospital, Durham, North Carolina.

Conflict of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Peter S. A. Glass, MBChB, FFA(SA), Department of Anesthesia, Stony Brook Medical Center, L4-060 HSC, SUNY, Stony Brook, NY. Address e-mail to

Accepted May 10, 2011

As a society matures, it becomes important to recognize what it stands for and those who have made significant contributions. The Board of the Society for Ambulatory Anesthesia (SAMBA) initiated the “Frontiers Lectureship” to be given by individuals who have made significant contributions to the practice of anesthesia, especially in the field of ambulatory anesthesia. For the 25th anniversary of the founding of SAMBA, it was very fitting to have as our Frontiers lecturer one of the founders of SAMBA, Dr. Burt Epstein. As Dr. Epstein describes in his lecture in this month's issue of Anesthesia & Analgesia,1 he was centrally involved in the development of the concepts and practice of ambulatory anesthesia. We as a specialty, a society, and as patients owe a great debt for his work in facilitating the growth of ambulatory surgery and anesthesia.

Anesthesiology is a relatively young and dynamic specialty. From the early days of open drop ether to current developments in closed-loop anesthesia, we have progressed rapidly over the past 150+ years. Among the most important advances in the past half-century is the transition of surgical procedures from the hospital setting to freestanding ambulatory surgical centers and physicians' offices. As described by Dr. Epstein, advances in the drugs available for anesthesia, and in the techniques used to provide anesthesia, have enabled the transition of nearly 70% of surgical procedures into the ambulatory environment.

The surge in popularity of ambulatory surgery in the United States has not been seen in most other countries. In the 1990s, on average only 10% of surgical procedures were performed as same-day surgery in European countries even though similar drugs and anesthesia practices existed on both continents. Even today, fewer than 25% of procedures are performed as same-day surgery in most European countries. A similarly low incidence of day surgery is also seen in Asia and Australia.

SAMBA was founded in 1984. Since then, the increase in surgical procedures performed in an ambulatory setting matched the strong and vibrant growth of SAMBA. The growth of SAMBA and the growth of ambulatory surgery in the United States are inextricably linked. SAMBA has had a major role in promoting the subspecialty of ambulatory anesthesia through education and advocacy. Ambulatory surgery and anesthesia have also been driven by financial pressures by payers within the United States, and by changes in patient expectations.

The growth of ambulatory surgery and anesthesia has also been facilitated by the focus on safe anesthesia practices. This emphasis continues, with patients having increasingly complex pathologies undergoing invasive procedures in the ambulatory environment. Drs. Bernie Wetchler, Surinder Kallar, and Burt Epstein intended for SAMBA to be a leader in promoting the safe practice of ambulatory anesthesia. They succeeded!

SAMBA is at a crossroads. Because most procedures are conducted on outpatients, is there enough difference between “anesthesia” and “ambulatory anesthesia” to justify a society dedicated to ambulatory practice? Are the needs and interests of those anesthesiologists who regularly practice ambulatory anesthesia (nearly all of us) better represented by our parent professional organization: the American Society of Anesthesiologists (ASA) than by a subspecialty society? If most surgery is ambulatory surgery, are ambulatory patients sufficiently “special” to justify the attention of a subspecialty society? We think so, provided SAMBA continues to be relevant and provide meaningful benefits to its members.

We believe SAMBA should continue to have a critical role for all anesthesiologists who practice in the ambulatory environment. To meet the needs of this constituency, SAMBA is now focusing on enhancing education and research in ambulatory anesthesia. These efforts are being provided in multiple forums, including SAMBA's annual and semiannual meetings, the Ambulatory Anesthesiology section within Anesthesia & Analgesia, collaborative efforts with the ASA in the publication of books and guidelines, panels within the annual ASA meeting, and more recently, the development of SAMBA-sponsored guidelines such as the management of postoperative nausea and vomiting2 and of the diabetic patient presenting for same-day surgery.3 This year will also see the relaunch of SAMBA's ambulatory anesthesia clinical research awards.

Perhaps the most exciting new initiative by SAMBA is the launching of the SAMBA Clinical Outcome Registry (SCOR). This registry is specifically designed for ambulatory practices. SAMBA has joined efforts with the Anesthesia Quality Institute and their National Anesthesia Clinical Outcomes Registry database to create a broad registry that will allow SAMBA to provide practices with individual reports on quality metrics. Using this registry, individual practices can prepare benchmarks against national norms. One of the advantages of SCOR is that the data collected and deposited in the registry are predefined. This allows reports generated for quality assurance purposes and best practices to be quickly prepared and disseminated. Quality metrics have an ever-increasing role in reimbursement for both physicians and facilities. As a result, access to quality metrics and performance is increasingly critical for our practices.

SAMBA has had a significant impact on the practice of anesthesia. We are grateful to the founders including Bernie Wetchler, Surinder Kallar, Burt Epstein, and others for their foresight. SAMBA will honor their legacy by remaining a vibrant and growing society, dedicated to improving the care of ambulatory patients.

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Name: Peter S. A. Glass, MBChB, FFA(SA).

Conflicts of Interest: Dr. Glass is the incoming President of SAMBA.

Name: Tong J. Gan, MBBS, MD, MHS, FRCA.

Conflicts of Interest: Dr. Gan is a past President of SAMBA.

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1. Epstein BS. Where we were, where we are, and where we are going. Anesth Analg 2011;113:480–3
2. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramer MR, Vander Kolk C, Watcha M; Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615–28
3. Joshi GP, Chung F, Vann MA, Ahmad S, Gan TJ, Goulson DT, Merrill DG, Twersky R; Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesth Analg 2010;111:1378–87
© 2011 International Anesthesia Research Society