Operated on in the morning, home in the evening

In short: Ambulatory surgery

Potential & situation: Data and international comparisons show great potential for ambulatory care.
Practice & implementation: Pilot indications, streamlined surgical procedures, and reliable follow-up care chains make ambulatory care safe and predictable.
Policy & financing: Sector-specific remuneration, temporary start-up funding, and clear KPIs are the levers for rapid scaling.

01.09.2025

What if nursing staff in hospitals were relieved of some of their workload and fewer costly beds capacities were necessary, without compromising patient safety? Up to 3.5 million inpatient cases per year in Germany could be treated equally well on an ambulatory care basis. This would save costs, reduce length of stay, and relieve the burden on nursing staff – provided that clinics, policymakers, and ambulatory care partners redesign processes and incentives. This multimedia report summarizes the status quo, the benefits, and the necessary steps.

Status quo: Surprisingly high ratio of inpatients

Germany has a strikingly high proportion of inpatient treatments for numerous routine indications compared to other countries. While countries such as Denmark and Canada organize many simple procedures as day cases, in Germany, a large proportion of these procedures remain inpatient. The result: unnecessary hospital stays, scarce bed capacity, and a heavy burden on nursing and surgical teams. This discrepancy is less a medical issue than a structural and incentive-driven one.

Simplified representation of some proportions for comparison of procedures performed on an inpatient basis in selected OECD countries (values from data year 2022). Individual values per indication; not cumulative.

Proportion of full inpatient procedures in selected OECD countries (in percent, values from data year 2022)

	Inguinal hernia surgery	Tonsillectomy	Cataract	Gallbladder removal	PTCA (coronary angioplasty)	Prostatectomy
Germany	99,7	80,5	12,3	100,0	98,9	100,0
Netherlands*	13,5*	15,4*	0,1*	59,8*	60,6*	100,0*
Denmark	14,1	28,0	0,5	55,0	79,0	59,4
France	26,7	50,0	2,7	55,8	91,6	94,5
Canada	19,4	25,3	0,1	43,6	84,4	67,2
United Kingdom	25,4	23,8	0,5	47,9	75,2	81,5
Switzerland	60,3	87,8	9,7	95,7	75,2	99,1

* Values Netherlands from 2021.

To clarify the terms: The figures shown here represent the percentage of inpatient cases for each indication. The missing percentages therefore represent ambulatory cases in the broader sense: Patients undergoing ambulatory surgery are often referred to internationally as day cases. The OECD data additionally distinguishes between “outpatient cases” and “day cases” for some (but not all) of the indications listed. Regardless of this, both variants are characterized by the fact that there is no inpatient admission or overnight stay in the hospital. This difference from inpatient treatment (which always includes an overnight stay) is particularly important for the evaluations presented here.

Source: Illustration by Prof. Dr. Jan-Marc Hodek based on data from OECD 2024.

Why outpatient care works: benefits at a glance

The increased use of ambulatory care for comparatively minor cases such as inguinal hernias, knee arthroscopy, cataract surgery, minor heart surgery, and ear, nose, and throat surgery significantly reduces the burden on inpatient care. Modern, minimally invasive procedures and improved anesthesia techniques mean that many procedures can be performed on an outpatient basis with the same quality of care. Patients benefit from shorter recovery times at home and a lower risk of infection. Prof. Dr. Jan-Marc Hodek, Dean of Studies for the Bachelor's degree program in Health Economics at RWU – Ravensburg-Weingarten University of Applied Sciences, explains in a video statement how this means fewer bed days, less need for night shifts, and freed-up specialist capacity for more complex cases for clinics.

In practice: How the daily routine at clinics is changing

Ambulatory procedures make everyday hospital life more predictable and results-oriented: fixed surgery schedules, standardized pre-surgery and discharge checks, and reliable follow-up care significantly reduce turnaround times and downtime in operating theatres, allow for more efficient use of human resources, and avoid unnecessary overtime. This lowers variable costs and improves the patient experience.

Smiling man with glasses in a brown jacket in front of a dark brown background - Philipp Henßler; Copyright: Fotografie Ebinger

"A clearly structured, ambulatory surgical setting creates predictable daily routines and reduces interface problems. Short-track structures make it possible to perform procedures at a fixed pace and deploy personnel resources in a targeted manner – this ensures less friction and greater efficiency in the interdisciplinary team."

Philipp Henßler
Gesundheitsökonom MBA

Implementation in clinics: What needs to be adapted

However, ambulatory care is not merely a change in billing, but a process. For successful implementation, the following applies:

Separate ambulatory pathways and process design (check-in, surgery, recovery, discharge in hours instead of days),
Clear indication catalogs and prequalification of patients,
Reliable aftercare chains, including telemedicine and clear escalation paths,
Clear indication catalogs and prequalification of patients,
Reliable aftercare chains, including telemedicine and clear escalation paths,
Training and change management for hospital staff,
IT support for appointment scheduling, documentation, and telemedical follow-ups.

Illustration showing three main benefits of ambulatory surgeries

The political lever: reimbursement and start-up financing

The main obstacle remains economic: as long as inpatient billing is more lucrative, there will be a strong incentive to perform procedures on an inpatient basis. International experience shows that short-term overpayments, start-up financing, or sector-specific models (e.g., hybrid DRGs) are effective instruments for stimulating investment in ambulatory care structures. Without such adjustments, the economic interest of many service providers will remain focused on inpatient billing.

Success factors: How ambulatory care quickly takes effect

Two elderly people leave a hospital at the same time as a doctor climbs a flight of stairs

"Ambulatory care is not a sure-fire success. Without adapted structures, reliable processes, and guaranteed follow-up care, there is a risk of economic missteps and gaps in care – especially for older patients or those with multiple illnesses. It is crucial to consistently align the entire setting with ambulatory logic."

Philipp Henßler
Gesundheitsökonom MBA

Ambulatory surgeries are not an end in themselves, but rather a practical lever for making care more efficient and patient-friendly without compromising on quality and safety. What matters is not so much the number of individual measures as their reliability: appropriate financial incentives, coordinated operational implementation, and safe follow-up care.

If politicians, hospital management, and outpatient care partners take these steps together, relief can be provided in the short term, and a more resilient care structure can be established in the long term.

Smiling woman with red hair and glasses - Melanie Prüser; This portrait was AI-generated.

Author: Melanie Prüser | Editorial team MEDICA-tradefair.com

Melanie Prüser has been writing about the exciting interface between medicine and technology for MEDICA.de since 2019. She is always on the lookout for the stories behind devices and applications to show how innovations directly change the everyday lives of medical professionals and patients.