Fighting the obesity pandemic during the COVID-19 pandemic

Safety and Feasibility of Same-Day Discharge After Primary Bariatric Surgery and the Value of Remote Monitoring with the Healthdot

BACKGROUND

Annually, more than 12,500 bariatric procedures are performed in the Netherlands. Same-day discharge (SDD) has been implemented in several surgical procedures and was recently introduced in bariatric metabolic surgery (BMS). However, the best way to safely facilitate this introduction is a subject of debate. This study aims to assess the feasibility of SDD in selected patients undergoing primary BMS and the value of remote monitoring with a wireless vital sign monitoring system (Healthdot).

METHODS

This retrospective study included all primary sleeve gastrectomy and Roux-en-Y gastric bypass procedures in the first year after the introduction of SDD in a large teaching hospital in the Netherlands. SDD patients were remotely monitored postoperatively for 7 days using the Healthdot which measured vital signs continuously. The primary outcome was the success rate of SDD. Secondary outcomes included readmissions, complication rate, and Healthdot alarms.

RESULTS

Out of 813 consecutive primary bariatric procedures between March 2022 and March 2023, there were 514 eligible patients of whom 260 were scheduled for SDD. Successful SDD was achieved in 246 patients (94.6%). Eight patients were readmitted within 48 h resulting in a success rate of 91.5%. Among 217 patients (83.5%) who went home with the Healthdot device, 28 alarms occurred of which 26 did not have a complication. In 11 other patients, a complication occurred without any alarms during the 7-day period.

CONCLUSIONS

SDD after primary bariatric procedures is considered safe if specific selection and discharge criteria are maintained. The Healthdot is found to be ineffective in predicting complications in this patient group.

Safety of gastric bypass with same-day discharge: a propensity score-matched analysis of the Dutch Audit for treatment of Obesity

BACKGROUND

Bariatric surgery with same-day discharge (SDD) is becoming increasingly common. Nevertheless, there is limited data available comparing gastric bypass patients with SDD to those with overnight hospitalization.

OBJECTIVE

The aim of this study was to investigate the short-term outcomes of gastric bypass with SDD compared to overnight hospitalization in The Netherlands.

SETTING

Retrospective database study with the use of the Dutch national registry.

METHODS

Patients who underwent gastric bypass surgery in 2022 were included and propensity score matching was performed to compare SDD with patients discharged on postoperative days (POD) 1-4. The primary outcome was the occurrence of severe complications within 30 days postoperative.

RESULTS

A total of 775 SDD patients were matched with 1550 patients discharged on POD 1-4. The occurrence of severe complications was .9% in both groups (P = 1.000), and there were no significant differences in reoperations or mortality. A significant difference was observed in the readmission rate, with 3.9% in the SDD group compared to 1.6% in the other group (P = .001). A proportionally small, yet statistically significant difference favored the control group regarding anastomotic leakages (.6% versus 0%, P = .004) and unspecified surgical complications (1.4% versus .5%, P = .028).

CONCLUSION

Gastric bypass with SDD is safe, with no increased risk of short-term severe complications, reoperations, or mortality. However, SDD is associated with a higher 30-day readmission rate compared to patients who stay overnight in the hospital after surgery.

Feasibility of same-day discharge after laparoscopic sleeve gastrectomy in the Netherlands

BACKGROUND

There is a trend towards laparoscopic sleeve gastrectomy (SG) with same-day discharge (SDD), as an efficient healthcare pathway to alleviate the burden on clinical capacity. This approach seems to be safe, if patients are carefully selected. In our bariatric center, a protocol for Roux-en-Y gastric bypass with SDD has already been successfully implemented. The aim of this study was to evaluate feasibility of applying the same SDD protocol for SG.

METHODS

A single-center prospective feasibility study was conducted at a high-volume bariatric center. Low-risk patients who were scheduled for primary SG were included. Strict criteria were used for approval upon SDD. The primary outcome was the rate of successful SDD without readmission within 48 h. Secondary outcomes included short-term complications, emergency department visits, readmissions, and mortality.

RESULTS

Fifty patients were included in the study, of whom 45 were successfully discharged on the same day of the surgery. Nausea and vomiting were the most common reasons for overnight hospitalization (three patients). One patient was readmitted within the first 48 h due to a mild complication related to bleeding, resulting in a success rate of 88% for SDD without readmission within 48 h. No severe complications or mortality were reported in the cohort.

CONCLUSION

Our SDD protocol for SG has demonstrated feasibility, with a high success rate of SDD and no severe complications. Strict conditions should be met for the safe implementation of a SDD protocol, including careful patient selection and the establishment of a safety net to detect early complications.