Challenges in establishing ambulatory surgery in a Moroccan general surgery department

Abstract

Ambulatory surgery has become widely used in high-income countries because it is safe, cost-effective, and optimizes hospital resources, yet its development remains limited in many low- and middle-income settings, including Morocco. This study evaluated the feasibility and outcomes of ambulatory digestive surgery in a Moroccan tertiary care hospital and sought to identify factors associated with failure of same-day discharge. Over one year, all adult patients scheduled for elective ambulatory digestive procedures were prospectively included, and their perioperative outcomes were analyzed. Among 595 procedures performed in 2022, 266 were initially planned as ambulatory, but 64 ultimately required unplanned overnight hospitalization, resulting in an effective ambulatory rate of 33.9%. Complication and readmission rates were low, and no 90-day mortality was observed, supporting the overall safety of this approach. However, ambulatory failure was frequently associated with advanced age, comorbidities, prior abdominal surgery, and, importantly, social factors such as illiteracy, lack of caregiver support, and distance from the hospital. These findings indicate that while ambulatory digestive surgery is feasible and safe in this setting, its broader implementation is strongly influenced by non-medical barriers. Strengthening perioperative education, reinforcing family involvement, and adapting organizational infrastructure are essential to expand ambulatory surgery in similar healthcare contexts.