Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis

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.

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 Same-Day Discharge Bariatric Surgery: A Comprehensive Analysis of 457 Cases Across Multiple Procedure Types

BACKGROUND

Outpatient bariatric surgery offers reduced hospital stays and healthcare costs, with promising safety outcomes. This study analyzes the short-term results of stand-alone primary and revision bariatric surgeries, alongside concomitant foregut and abdominal surgeries associated with bariatric procedures, to assess their safety and efficacy in an outpatient setting at a free-standing ambulatory center.

METHODS

A retrospective study was conducted on 457 same-day discharge (SDD) bariatric cases performed by a single surgeon at a free-standing ambulatory center between January 2021 and July 2024. The procedures included sleeve gastrectomy (SG), duodenal switch (DS), adjustable gastric band (AGB) removal, and Roux-en-Y gastric bypass (RYGB). Concomitant foregut and abdominal surgeries associated with bariatric procedures, such as hiatal hernia repair (HHR), cholecystectomy, fundoplication, and ventral hernia repair, were performed when clinically indicated.

RESULTS

Of the 457 cases, 97.8% were primary surgeries, and 2.1% were revisions. Stand-alone procedures accounted for 39.3%, and 60.6% were concomitant. SG constituted 74.8% of cases, followed by HHR (16.1%), DS (5.4%), AGB removal (2.6%), and RYGB (.8%). The mean operative time was 79.9 ± 24.3 min, with a mean length of stay of 3 h 52 min (± 1:10). The 30-day complication rate was 2.1%, with Clavien-Dindo grade IIIb complications in .8% of patients. Patient satisfaction was high, with a mean score of 9.8.

CONCLUSIONS

Outpatient bariatric surgeries demonstrated strong safety with minimal complications, underscoring their viability in carefully selected patients. Staged approaches for complex cases further optimized outcomes, making outpatient settings a robust option for a wide range of bariatric procedures.

Analysis of emergent reoperations after bariatric surgery: an important metric for safe same-day surgery

BACKGROUND

Early reoperation after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) is a severe adverse event that may increase the risk of perioperative mortality if there is a delay in care. However, it is unclear what proportion of reoperations occur within 24 hours of surgery and who is at greater risk, which may impact the safety of performing safe same-day surgery.

OBJECTIVES

To evaluate the incidence of reoperation in the first 24 hours after primary SG and RYGB.

SETTING

Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.

METHODS

Using a statewide bariatric surgery data registry, patients undergoing primary SG (n = 49,848) and RYGB (n = 11,267) cases were analyzed. Patients who had a subsequent reoperation were identified and reasons for reoperation were compared between those occurring <24 hours versus >24 hours. In addition, patients who underwent a reoperation <24 hours were compared with patients who underwent primary SG or RYGB and did not experience any complications.

RESULTS

The overall rate of reoperation was .72% for SG and 2.1% for RYGB. Reoperation <24 hours of index procedure was 32.0% after SG and 24.2%, after gastric bypass, with the most common reason being hemorrhage (86.15%% and 55.4% respectively). Older age, hypertension, liver disease, and longer operative times were associated with reoperation <24 hours after SG, whereas longer operative times were associated with reoperation <24 hours after RYGB. Concurrent hiatal hernia repair was not associated with increased risk.

CONCLUSIONS

Reoperation after primary bariatric surgery is rare but occurs within 24 hours in approximately one third of the cases after SG and one quarter of cases after RYGB. Older patients with significant comorbidities are at increased risk and should be considered poor candidates for same-day surgery given the possibility of an early life-threatening event.

Impact of same-day sleeve gastrectomy surgery on postoperative emergency department visits: analysis from the Michigan Bariatric Surgery Collaborative

BACKGROUND

Same-day discharge after sleeve gastrectomy (SDDSG) is being performed in select patient populations with increased regularity since 2020.

OBJECTIVES

To evaluate the impact of SDDSG on emergency department (ED) visits.

SETTING

Academic and private practice bariatric surgery programs participating in a statewide quality improvement collaborative.

METHODS

Using a statewide bariatric specific data registry, all patients undergoing SDDSG between 2020 and 2023 were identified (n = 984). Rates of 30-day ED visits and complications were compared between SDDSG and a 2:1 propensity-matched cohort with a 1-2-day hospital length of stay (n = 1968).

RESULTS

The mean age and body mass index of SDDSG patients were 41.7 years and 45.9, respectively. When compared to the matched cohort, SDDSG patients had higher rates of ED visits (9.2% versus 6.2%, P = .0029), were more likely to present to ED earlier (10.3 days versus 12.9 days, P = .0118), and were less likely to require hospital admission (87.8% versus 71.1%, P < .0037), even though the overall complication rates were similar (4.7% versus 3.7%, P = .2087). The most common reason for an ED visit after SDDSG was nausea, vomiting, and dehydration (58.9% versus 66.9%, P = .2294), and the most common day to present to the ED was Friday (20.0% versus 20.7%, P = .9061), which was similar between groups.

CONCLUSIONS

Despite having similar complication rates, patients undergoing SDDSG were more likely to present to the ED after surgery when compared to a matched cohort of patients with a 1-2-day hospital stay.

Remote Patient Monitoring Following Same-Day Discharge Bariatric Surgery: A Systematic Review and Meta-analysis

BACKGROUND

A barrier to same-day discharge (SDD) in bariatric and metabolic surgery (BMS) is concern over missing the early signs of complication, often detected by measurement of physiological observations. Remote patient monitoring has gained popularity in other surgeries; however, its effectiveness in BMS remains uncertain. This systematic review aims to examine the impact of remote monitoring (RM) on postoperative readmissions and complications in patients undergoing SDD after BMS.

METHODS

A literature search of Embase, Ovid MEDLINE, and Cochrane Central databases was conducted to identify all studies on RM used in SDD in bariatric surgery. Data were collected on patient demographics and postoperative outcomes including readmission and morbidity rates.

RESULTS

Seventeen studies including 20,380 patients were analysed. The mean age and preoperative body mass index (BMI) of patients were 41.3 ± 2.7 years and 43.3 ± 1.6 kg/m2 respectively. The incidence of readmission for patients with and without RM was 6% (95% CI 0.03-0.13) and 2% (95% CI 0.01-0.04) respectively (p = 0.01). The overall complication rates for patients with and without RM were found to be 7% (95% CI 0.04-0.13) and 3% (95% CI 0.02-0.09) (p = 0.08). Most of the patients who were readmitted had a Clavien-Dindo score of 1 or 2 (68%). There was no mortality described in studies with the use of RM.

CONCLUSIONS

SDD with RM enables a shorter hospital stay while providing a safety net for patients and clinicians; the readmission rate is expected marginally higher given the early discharge date. Future studies reporting on healthcare economics are encouraged.

Same Day Discharge after Metabolic and Bariatric Surgery in Adults 65 Years and Older: An Analysis of the 2015 to 2022 MBSAQIP

BACKGROUND

There is increasing interest in same day discharge (SDD) after metabolic and bariatric surgery (MBS). Among older adults, the safety of SDD is unclear and, as a result, this age group is often excluded from SDD protocols. We aimed to characterize the safety profile of SDD in adults ≥ 65 years.

METHODS

The 2015-2022 MBSAQIP was queried for patients ≥ 65 years undergoing primary sleeve gastrectomy or RYGB. Patients were stratified based on postoperative day (POD) of discharge: SDD, POD1, POD2, POD3, and ≥ POD4. Logistic regression was used to examine associations between SDD and 30-day Clavien-Dindo complications and readmissions.

RESULTS

We identified 63,486 patients ≥ 65 years; the median (IQR) age was 68 (4) years. Overall, 2.12% of patients underwent SDD while the majority (52.8%) were discharged on POD1. From 2015 to 2022, the proportion with SDD increased from 1.15% to 4.33%. Compared to those discharged on later days, patients undergoing SDD had proportionally fewer obesity-associated diseases, including insulin-dependent diabetes (SDD 14.2%, POD1 15.5%, POD2 20.4%, POD3 23.2%, POD4 + 26.1%) and COPD (SDD 3.2%, POD1 4.7%, POD2 5.7%, POD3 7.2%, POD4 + 9.6%) (all p < 0.001). Compared to POD1 discharge, SDD was not significantly associated with any class of Clavien-Dindo complications or 30-day readmissions (all p > 0.05).

CONCLUSIONS

Though use of SDD after MBS in adults ≥ 65 years has increased from 2015 to 2022, it remains an uncommon practice. Those undergoing SDD have fewer obesity-associated diseases and, in this select cohort of older adults, SDD is not associated with worse postoperative morbidity and mortality. Careful patient selection is critical for safe SDD in adults ≥ 65 years.

Perioperative outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass using the MBSAQIP database

BACKGROUND

There has been a rising trend of outpatient bariatric surgery, particularly accelerated by the COVID-19 pandemic. The aim of this study was to evaluate the safety and outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass (LRYGB) using the MBSAQIP database.

METHODS

In this retrospective study, the MBSAQIP was queried for patients undergoing non-revisional LRYGB between 2020 and 2021. Two cohorts were established: same-day discharge (SDD; length of stay = 0 days) and next-day discharge (POD1; length of stay = 1 day), with the latter serving as a control group. Univariate analysis and multivariate logistic regression were employed to compare outcomes between cohorts.

RESULTS

A total of 48,408 patients underwent LRYGB, with 1,918 (4.0%) SDD and 46,490 (96.0%) POD1. The two cohorts were similar in mean age (SDD 44.2 ± 11.3 years vs POD1 44.0 ± 11.3 years; p = 0.61) and female sex (SDD 83.8% vs POD1 83.1%; p = 0.43). However, the POD1 cohort had a higher preoperative body mass index (45.4 ± 7.3 vs 44.9 ± 7.3 kg/m2; p < 0.01). Preoperative anticoagulation and obstructive sleep apnea were more prevalent in the POD1 group. There was no difference in overall 30-day overall complication rates (SDD 2.0% vs POD1 2.3%; p = 0.51), reintervention, reoperations, mortality, and emergency department visits between the two cohorts. Readmissions were lower in the SDD cohort (2.9% vs 4.0%; p = 0.02), whereas the need for outpatient intravenous hydration was higher in the SDD cohort (6.7% vs 3.6%; p < 0.01). This finding remained significant even after adjustment for confounders.

CONCLUSION

Same-day LRYGB is safe and feasible, with comparable complication rates to next-day discharge. Notably, SDD is associated with lower readmission rate and higher need for outpatient intravenous hydration, possibly reflecting rigorous bariatric protocols and thorough patient follow-up. Further investigations are warranted to elucidate the selection criteria and optimize postoperative care for outpatient LRYGB.

Anastomotic metabolic and bariatric surgeries with same-day discharge: 30-day outcomes of a cohort from a high-volume center in Canada

BACKGROUND

On the basis of our extensive experience in same-day discharge (SDD) sleeve gastrectomy, we extended this management strategy to anastomotic metabolic and bariatric surgeries (MBS).

OBJECTIVES

To retrospectively analyze early outcomes (≤30 d) after anastomotic MBS with planned SDD (≤12 hr).

SETTING

University Hospital, Canada; Public Practice.

METHODS

SDD anastomotic MBS were proposed with strict preoperative criteria and included single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and single-anastomosis sleeve ileal bypass (SASI). Enhanced recovery after bariatric surgery protocols and post-anesthesia care unit criteria were followed. Unplanned overnight stay, emergency department (ED) visit, readmission, morbidity-mortality, and reintervention rates were analyzed.

RESULTS

Since 2021, 208 patients (191 female and 17 male) have undergone SDD anastomotic MBS, with 76% conversion procedures: 92 SADI-S, 72 RYGB, 35 OAGB, and 9 SASI (mean age = 41.4 yr and mean preoperative body mass index = 41.9 kg/m2). Unplanned overnight stays and ED visits were 4.8% and 4.3%, respectively. Readmission rate was 5.8% (5 SADI-S, 5 RYGB, 1 OAGB, and 1 SASI). Overall morbidity rate was 14.9%, including 3.9% major complications. Within 30 days postoperatively, there were 2 duodenal leaks, 1 intrabdominal collection, 1 common bile duct stenosis, and 1 acute appendicitis in the SADI-S group. There were 2 occlusions on the jejunojejunal anastomosis and 1 bleeding on the gastrojejunal anastomosis in the RYGB group. Five (2.4%) required reintervention with no mortality.

CONCLUSIONS

We report low and acceptable rates of unplanned overnight stay, readmission, and reintervention. Early outcomes suggest that SDD anastomotic MBS seems safe and feasible with an experienced team, selective criteria, and appropriate postoperative follow-up.

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.

Safety and factors associated with early discharge in revisional laparoscopic Roux-en-Y gastric bypass: analysis of the MBSAQIP database

BACKGROUND

Improvements in bariatric surgery outcomes have prompted policy initiatives that explore shifting bariatric surgery toward outpatient procedures. While the safety of early discharge after primary laparoscopic Roux-en-Y gastric bypass (LRYGB) has been reported, its safety for revisional LRYGB remains uncertain. Our study aimed to investigate the safety and patient factors associated with early discharge in patients undergoing revisional LRYGB compared with primary LRYGB.

METHODS

We identified adult patients who underwent primary and revisional LRYGB from 2020 to 2022 in the MBSAQIP database. Patients discharged early, i.e., same-day discharge (SDD) and next-day discharge (NDD) were compared to inpatients. Outcomes included 30-day complications (minor = Clavien-Dindo 1-2; major = Clavien-Dindo 3-4), mortality, readmissions, and reoperations. Multivariable logistic regression models adjusting for patient demographics, comorbidities, and operative time were fitted to assess the study outcomes.

RESULTS

SDD rate was similar after primary (3,422/137,406; 2.5%) and revisional LRYGB (781/32,721; 2.4%), while NDD rate was higher in primary LRYGB (59.8% vs 54.7%, respectively; p < 0.001). SDD patients had lower odds of major complications compared to inpatients following primary (2% vs 7%, aOR: 0.30, 95%CI 0.24-0.38) and revisional LRYGB (3.7% vs 9.3%, aOR: 0.43, 95%CI 0.29-0.62, respectively). NDD patients had similarly lower odds of morbidity outcomes. ASA Classification IV/V was associated with lower odds of SDD compared to Class I/II (Primary: 0.9% vs. 3%, aOR: 0.61, 95% CI 0.48-0.78; Revisions: 0.9% vs. 3%, aOR: 0.24, 95%CI 0.10-0.55).

CONCLUSION

Early discharge after revisional LRYGB, particularly after an overnight stay, can be accomplished safely in carefully selected patients. However, SDD rates remain low limiting its safety assessment. Further, almost half of the patients stay more than 48 h in the hospital suggesting that policy initiatives toward outpatient management after bariatric surgery may be inappropriate for this patient population.

Bariatric Surgery: Current Trends and Newer Surgeries

Bariatric surgery has evolved and gained in popularity as it has been recognized as the most sustainable and effective treatment for obesity and related diseases. These related diseases are significant causes of obesity related morbidity and mortality. Most bariatric procedures incorporate some component of gastric restriction with or without intestinal bypass, but the full mechanism of these procedures has yet to be elucidated. The most popular surgical procedure remains the sleeve gastrectomy over the last 10 years, while gastric bypass is also still commonly performed. We have also seen growth in revisional bariatric surgery and novel surgical procedures.

Outcomes of same-day discharge in bariatric surgery

BACKGROUND

Restrictions during the COVID-19 pandemic influenced a shift to same-day discharge in bariatric surgery. Current studies show conflicting findings regarding morbidity and mortality. We aim to compare outcomes for same-day discharge versus admission after bariatric surgery.

METHODS

Subjects included patients who underwent primary laparoscopic or robotic-assisted sleeve gastrectomy or Roux-En-Y gastric bypass at an academic center. The inpatient group included patients discharged postoperative day one, and the outpatient group included patients discharged on the day of surgery. Primary outcomes included the number of emergency room visits, reoperations, IV fluid treatments, readmissions, and mortality within 30 days. Secondary outcomes were morbidity, including skin and soft tissue infection, pulmonary embolism, and acute kidney injury.

RESULTS

1225 patients met the inclusion criteria. In the gastric sleeve group, 852 subjects were outpatients and 227 inpatients. In the gastric bypass group, 70 subjects were outpatients, and 40 were inpatients. The mean age was 44.63 (17.38-85.31) years, and the mean preoperative BMI was 46.07 ± 8.14 kg/m2. The subjects in the outpatient group had lower BMI with fewer comorbidities. The groups differed significantly in age, BMI, and presence of several chronic comorbidities. The inpatient and outpatient groups for each surgery type did not differ significantly regarding reoperations, IV fluid treatments, or 30-day mortality. The inpatient sleeve group demonstrated a significantly higher readmission percentage than the outpatient group (4.6% vs 2.1%; p = 0.02882). The inpatient bypass group showed significantly greater ER visits (21.7% vs 10%; p = 0.0108). The incidence of adverse events regarding the secondary outcomes was not statistically different.

CONCLUSION

Same-day discharge after bariatric surgery is a safe and reasonable option for patients with few comorbidities.

Ambulatory bariatric surgery: a prospective single-center experience

BACKGROUND

Ambulatory bariatric surgery has recently gained interest especially as a potential way to improve access for eligible patients with severe obesity. Building on our previously published research, this follow-up study delves deeper in the evolving landscape of ambulatory bariatric surgery over a 3-year period, focusing on predictors of success/failure.

METHODS

In a prospective single-center follow-up study, we conducted a descriptive assessment of all eligible patients as per our established protocol, who underwent a planned same-day discharge (SDD) primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 03/01/2021 and 02/29/2024. Trends in SDD surgeries over time were assessed over six discrete 6 month intervals. Primary endpoint was defined as a successful discharge on the day of surgery without emergency department visit or readmission within 24 h. Secondary outcomes included 30-day postoperative morbidity.

RESULTS

A total of 811 primary SG and 325 RYGB procedures were performed during the study period. Among them, 30% (n = 244) were SDD-SGs and 6% (n = 21) were SDD-RYGBs, respectively. At baseline, median age of the entire SDD cohort was 43 years old, 81% were females, and body mass index (BMI) was 44.5 kg/m2. The planned SDD approach was successful in 89% after SG (n = 218/244) and in 90% after RYGB (n = 19/21). Nausea/vomiting was the main reason for a failed SDD approach after SG (46%). The 30-day readmission rate was 1.5% (n = 4) for the entire SDD cohort including only one readmission in the first 24 h. The percentage of SDD-SGs performed as a proportion of total SGs increased over the initial five consecutive six-month intervals (14%, 25%, 24%, 38%, and 49%).

CONCLUSION

Our SDD protocol for bariatric surgery demonstrates a favorable safety profile, marked by high success rate and low postoperative morbidity. These outcomes have led to a continued increase in ambulatory procedures performed over time especially SG.

Predictive factors for readmission after bariatric surgery: Experience of an obesity center

Avoidable readmissions after bariatric surgery are a major burden on the healthcare systems. Rates of readmission after bariatric surgery have ranged from 1% up to 20%, but the factors that predict readmission have not been well studied. The objective of this study was to determine readmission rates following bariatric surgery and identify factors that contribute to early (within 90 days of surgery) and late readmission. A retrospective cohort study of 736 patients undergoing either Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass in Jordan University Hospital from 2016 to 2019. Demographic characteristics, co-morbidities, and readmissions were extracted from their medical records and analyzed. Multivariable logistic regression analysis was performed to determine which factors predict readmission. A total of 736 patients had bariatric surgery (Laparoscopic Sleeve Gastrectomy 89% vs Laparoscopic Roux-en-Y Gastric Bypass 11%) during the study period. Thirty-day readmission rate was 6.62% and an overall readmission rate of 23.23%. Common reasons for early readmission (within 90 days of surgery) were nausea, vomiting, and dehydration. Late readmissions were mainly caused by gallbladder stones. Three risk factors were identified that independently predicted readmission: the type of procedure being performed (P-value = .003, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.32-3.49), depression (P-value = .028, OR 6.49, 95% CI 1.18-52.9) and preoperative body mass index (P-value = .011, OR 1.03, 95% CI 1.01-1.05). Several factors were identified that cause patients to represent and subsequently admitted into hospitals. Early readmission was usually due to nausea, vomiting, and dehydration, whereas late admissions were mostly due to biliary complications. Preoperative body mass index and depression were independent risk factors for readmission.

Patient Satisfaction and Experience with Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass: A Mixed-Methods study

INTRODUCTION

Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is a safe and effective healthcare pathway. However, there is limited understanding of the patient perspective on SDD. The aim of this study was to explore patient satisfaction and experience with SDD after RYGB.

METHODS

A mixed-methods study with a concurrent design was conducted in a Dutch teaching hospital, using questionnaires and interviews. Patients who underwent RYGB and were discharged on the day of the surgery completed four questionnaires of the BODY-Q (satisfaction with the surgeon, satisfaction with the medical team, satisfaction with the office staff, and satisfaction with information provision) ± 4 months postoperative. The results of the questionnaires were compared with pre-existing data from a cohort of patients who stayed overnight after surgery (i.e., control group). A subset of patients was individually interviewed for an in-depth understanding of the patient perspective on SDD.

RESULTS

In the questionnaires, median scores for the control group (n = 158) versus the present group of patients (n = 51) were as follows: 92/100 vs. 92/100 (p = 0.331) for the surgeon, 100/100 vs. 92/100 (p = 0.775) for the medical team, 100/100 vs. 100/100 (p = 0.616) for the office staff, and 90/100 vs. 73/100 (p = 0.015) for information provision. Interviews with 14 patients revealed seven themes, describing high satisfaction, along with several points of interest.

CONCLUSIONS

Patient satisfaction with SDD after RYGB is high, although information provision regarding the day of surgery could be improved. However, not every medically eligible patient might be suitable for this healthcare pathway, as responsibilities are shifted.

Fully ambulatory robotic single anastomosis duodeno-ileal bypass (SADI): 40 consecutive patients in a single tertiary bariatric center

BACKGROUND

Single Anastomosis Duodeno-Ileal bypass (SADI) is becoming a key option as a revision procedure after laparoscopic sleeve gastrectomy (LSG). However, its safety as an ambulatory procedure (length of stay < 12 h) has not been widely described.

METHODS

A prospective bariatric study of 40 patients undergoing SADI robotic surgery after LSG with same day discharge (SDD), was undertaken in April 2021. Strict inclusion and exclusion criteria were applied and the enhanced recovery after bariatric surgery protocol was followed. Anesthesia and robotic procedures were standardized. Early follow-up (30 days) analyzed postoperative (PO) outcomes.

RESULTS

Forty patients (37 F/3 M, mean age: 40.3yo), with a mean pre-operative BMI = 40.5 kg/m2 were operated. Median time after LSG was 54 months (21-146). Preoperative comorbidities included: hypertension (n = 3), obstructive sleep apnea (n = 2) and type 2 diabetes (n = 1). Mean total operative time was 128 min (100-180) (mean robotic time: 66 min (42-85)), including patient setup. All patients were discharged home at least 6 h after surgery. There were four minor complications (10%) and two major complications (5%) in the first 30 days postoperative (one intrabdominal abscess PO day-20 (radiological drainage and antibiotic therapy) and one peritonitis due to duodenal leak PO day-1 (treated surgically)). There were six emergency department visits (15%), readmission rate was 5% (n = 2) and reintervention rate was 2.5% (n = 1) There was no mortality and no unplanned overnight hospitalization.

CONCLUSIONS

Robotic SADI can be safe for SDD, with appropriate patient selection, in a high-volume center.

Updates in Bariatric Surgery

Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.

Patient's Preference for Same-Day Discharge or Hospitalization After Bariatric Surgery

PURPOSE

Enhanced Recovery After Bariatric Surgery protocols have proven to be effective in reducing complication rates and length of stay. Guidelines do not include a recommendation on the length of hospital stay whereas same-day discharge is currently widely investigated on safety and feasibility. However, none of these studies takes patient preferences into account. The study aimed to reveal the patient's preference for outpatient surgery (OS) in patients who underwent primary bariatric surgery.

MATERIALS AND METHODS

A single-center preference-based randomized trial was performed between March and December of 2021. Adult patients planned for primary bariatric surgery were able to choose their care pathway, either OS with remote heart and respiratory rate monitoring by a wearable data logger or standard care with at least one-night hospitalization.

RESULTS

Out of the 202 patients, nearly everyone (98.5%) had a preference. Of 199 patients, 99 (49.7%) chose inpatient surgery. Of the 100 with a preference for OS, 23 stayed in the hospital due to medical reasons and 12 patients changed their preference. Based on both initial preference and changed preference, there were no differences between sex, age, body mass index, and co-morbidities such as diabetes mellitus, hypertension, and atrial fibrillation, nor in the use of anticoagulants or type of surgery.

CONCLUSION

Patients seemed to have a strong preference for their stay after a bariatric procedure. The preference is equally divided between outpatient and inpatient surgery and is not influenced by any patient characteristics.

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.

Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass: a Cohort of 500 Consecutive Patients

INTRODUCTION

There is an increasing demand on hospital capacity worldwide due to the COVID-19 pandemic and local staff shortages. Novel care pathways have to be developed in order to keep bariatric and metabolic surgery maintainable. Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is proved to be feasible and could potentially solve this challenge. The aim of this study was to investigate whether SDD after RYGB is safe for a selected group of patients.

METHODS

In this single-center cohort study, low-risk patients were selected for primary RYGB with intended same-day discharge with remote monitoring. All patients were operated according to ERAS protocol. There were strict criteria on approval upon same-day discharge. It was demanded that patients should contact the hospital in case of any signs of complications. Primary outcome was the rate of successful same-day discharge without readmission within 48 h. Secondary outcomes included short-term complications, emergency department visits, readmissions, and mortality.

RESULTS

Five hundred patients underwent RYGB with intended SDD, of whom 465 (93.0%) were successfully discharged. Twenty-one patients (4.5%) were readmitted in the first 48 h postoperatively. None of these patients had a severe bleeding. This results in a success rate of 88.8% of SDD without readmission within 48 h.

CONCLUSIONS

Same-day discharge after RYGB is safe, provided that patients are carefully selected and strict discharge criteria are used. It is an effective care pathway to reduce the burden on hospital capacity.