Belgium is not the first country where surgery was done in "one day setting", but, we must say that the enthusiasm of Dr. Claude Delathouwer, from the Brussels One Day Clinic, was the start of international contacts, and finally, to the foundation of the International Association for Ambulatory Surgery (I.A.A.S.).

The I.A.A.S. is an International Non-profit Association with its registered office in Belgium.

Belgium and Day Surgery

About the Belgian situation, in terms of Day Surgery, I wanted to start as early as 1963. But, a law on hospital organisation, described below, prevented us from doing so.

A hospital was defined as an institution where one was accepted for surgery or for another treatment and where everything was organised to give the patient a good stay or journey. Even the mentality amongst the patients and the people was "you better stay 2 or 3 more days in the hospital because of the good after-care, the good food, the warmth in winter, because of the visits of your family and friends…..".

The functioning of the hospital was based on "charity" and the nurses did the after-care during the hospital-stay.  The bill had to be paid when leaving the hospital and patient got refund by the National Insurance under condition of overnight stay.

Few years later, there was some change in the refund system, and we had to wait until 1985 for a law, changing the definition of "hospital" and allowing refund of surgeon’s fee and hospital cost even without overnight stay.

Finally, in 1997, the Government formulates the rules, terms and conditions for the organisation of Day Case Surgery. However, in the mean time, most hospitals in Belgium already had their Day Surgery Centre and some specialists, like, Ophthalmologist, Plastic Surgeons, started practice in free-standing centres.

From then on, different initiatives were taken by the Government to stimulate the implementation of the day surgery concept. The financing system for the hospital changed in favour of the day surgery concept for a certain category; and also the surgeons were stimulated to treat their patients on an out-patient base, by paying them a bonus (but a very little one!) when using the day surgery facilities.

Day Surgery evolution:

The situation in the countries around Belgium is different because of the lack of hospitals and hospital beds. Long waiting lists were created. And this is then the story of Dr. J. Nicoll , paediatric surgeon at the Sick Children’s Hospital, Glasgow, Scotland and called "the founder of the modern day surgery" (Prof. P. Jarrett, UK).

At that time (1880) in Glasgow, poverty was widespread and child mortality was high. At the Sick Children’s Hospital, they could treat only 500 children a year and there were always cases waiting for admission. Therefore, the hospital opened a dispensary as an out-patient department. Initially with two trained nurses, working independently from the inpatient hospital: in the morning working in the dispensary and in the afternoon visiting the patients at their homes.

From 1889 on, Nicoll started to follow up the results of the outpatient treatment and gave a presentation at a meeting of the British Medical Association with his successfully results.

In Belgium, it was Dr. Delathouwer, who was the man after the initiative to establish ambulatory surgery in the national forum. As stomatologist and director of the Brussels One Day Clinic, he organised the first Belgian and European Congress on Ambulatory Surgery (Brussels, 1991). This congress was very successful with 600 delegates from 25 countries, all interested in the concept of ambulatory surgery.

Also, it was decided to create an organisation called "Belgian Association of Ambulatory Surgery (BAAS)" to stimulate the organisation of ambulatory surgery and research in this field, to organise congresses and to give support to all kind of activities promoting ambulatory surgery. Anyone, interested in the concept could become a member.

The IAAS was founded on the 15th of March, 1995 and Dr. Delathouwer, was elected as the first President. In 1996, IAAS was officially constituted.

In 1999, during a Nicoll Memorial Lecture, at the 3rd International Congress of Ambulatory Surgery in Venice, Italy, Dr. Claude Delathouwer observed: "How it is possible that the following 50 – 60 years no reports are available relating to ambulatory practice,……it seems that modern ambulatory surgery was reinvented approximately 30 years ago….", commenting on the lack of publications or presentations on Ambulatory surgery.

In the mean time he organised the 2nd European Congress (Brussels, 1993), 3rd European and 1st International Congress (Brussels, 1995).

Belgian Congresses organised were: 2nd Belgian Congress, Brussels 1997, 3rd Belgian Congress, Brussels 1998, 4th Belgian Congress, Brussels 2000, 5th Belgian Congress, Leuven 2003, (Joint Congress with the Department of Anaesthesiology, University Hospitals, Catholic University of Leuven, International Winter Symposium on "Anaesthesia for Day Case Surgery".

From 2005 on, the B.A.A.S. vzw-asbl participates in the new structure of the Royal Belgian Society of Surgery (RBSS) and the Board decided to organise his own Congress every second year.

So the next Congresses were organised as follows:

6th Belgian Congress, 2005 Gent, 7th Belgian Congress, 2007 Neder-over-Heembeek, and 8th Belgian Congress, 2009 Neder-over-Heembeek.

In 2002, 2004, 2006 and 2008 the BAAS participated in the Belgian Surgical Week (BSW) , organised by the Royal Belgian Society of Surgery (RBSS), with a session, dedicated to the ambulatory concept.

Since the beginning the BAAS organised different surveys amongst the Ambulatory Surgery Centres in Belgium: one about "Patient’s satisfaction" (1998) and another about "Nurse’s satisfaction" (1999). A register of the existing Ambulatory Centres was published in 1998 and a new volume is foreseen in 2009.

Many things are changing in the acceptation of the ambulatory surgery concept. Government, hospitals, surgeons, anaesthetists, nursing staff and administrators are convinced that this concept is a good one. The hot topic on our last Congress (2009) was the shift to office based surgery. This means that more surgery will be done in outpatient setting and in these, we all will have to take up our responsibility to take care of the safety of our patient.