Bariatric Surgery Performed at a Tertiary Care Hospital and an Ambulatory Hospital: A 5 Year Comparison of Outcomes, OR Efficiencies and Costs

Safety Outcomes in Same-Day Discharge Anastomotic Metabolic/Bariatric Surgery vs Regular Overnight Discharge Protocol: A Systematic Review and Meta-analysis

Same-day discharge (SDD) protocols for anastomotic metabolic and bariatric surgery (MBS) have emerged as a strategy to optimise healthcare resources. However, concerns regarding safety, particularly related to mortality and postoperative complications, remain unresolved. This meta-analysis aimed to compare the safety of SDD with standard overnight hospitalisation (OH) in anastomotic MBS, focusing on early postoperative outcomes. A systematic review and meta-analysis were conducted following PRISMA and MOOSE guidelines. Four studies, including 19,849 patients (24.4% undergoing SDD), were analysed. Outcomes assessed included 30-day overall morbidity, mortality, readmission, reoperation rates and complications categorised by the Clavien-Dindo classification. A random-effects model was used for data pooling, and heterogeneity was assessed using the I2 statistic. SDD was associated with a significantly higher risk of 30-day mortality (OR 7.24; 95% CI 2.27-23.52; p = 0.001; I2 = 26%) and overall morbidity (OR 1.89; 95% CI 1.29-2.76; p = 0.001; I2 = 4%) compared to OH. No significant differences were observed in readmission (OR 1.17; 95% CI 0.61-2.22; p = 0.64; I2 = 79.1%) or reoperation rates (OR 0.98; 95% CI 0.47-2.03; p = 0.96; I2 = 61%). Interestingly, SDD was associated with a significantly lower rate of major complications (Clavien-Dindo grade III/IV) compared to OH (OR 0.64; 95% CI 0.44-0.91; p = 0.013; I2 = 9%). The observed increase in mortality and morbidity among SDD patients underscores the need for stringent patient selection, standardised discharge protocols and robust follow-up systems. Prospective studies are required to refine SDD protocols and ensure their safe implementation.

From database to practice: the MBSAQIP in the surgical literature

BACKGROUND

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has been a game changer for metabolic and bariatric surgery (MBS), with continuous improvements in safety and outcomes throughout the years of its usage. It allows in-depth evaluations of MBS procedures, presenting practitioners and researchers with unparalleled opportunities for quality assessment, research and clinical advancement.

OBJECTIVES

To offer an updated overview of MBSAQIP-related publications.

SETTING

United States.

METHODS

PubMed was queried using keywords "MBSAQIP" and "Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program." Letters to editors, duplicates, commentaries, and retracted articles were excluded. Studies that mentioned MBSAQIP but did not use the data within were also excluded.

RESULTS

A total of 400 search items were returned as of August 2023. After exclusions, 289 studies were reviewed. Articles were published in a total of 28 unique journals, the majority of which were featured in Surgery for Obesity and Related Diseases (SOARD), with 114 articles (39.4%). Sixty-one articles were focused on creating predictive models or risk calculators, 58 on investigating the safety of procedures, and 52 on exploring complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were the 2 most commonly discussed procedures, at 80.3% and 80% respectively. Forty-three studies included patients who underwent robotic-assisted MBS.

CONCLUSIONS

The MBSAQIP is a valuable resource that has generated a wealth of studies in the literature. It has allowed for intense analysis of clinical issues and fostered a culture of safety and quality improvement. Participating surgeons must pledge commitment to extended follow-up periods to maximize its effectiveness.