How safe is same-day discharge after laparoscopic sleeve gastrectomy?

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is associated with low morbidity and mortality and a short length of stay. Studies on the safety of same-day discharge after LSG are limited.

Objective: To compare outcomes between same-day versus first-postoperative-day (POD1) discharge after LSG.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database.

Methods: The 2015 to 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was analyzed for elective LSG cases with same-day or POD1 discharge. Open, revisional, and converted cases were excluded. Multivariate analysis was performed to compare adjusted 30-day mortality, morbidity, readmission, and reoperation for same-day versus POD1 discharge.

Results: We examined 85,321 LSG cases, including 4728 same-day discharges and 80,593 POD1 discharges. Compared with POD1 discharges, same-day discharges were associated with higher overall morbidity (1.31% versus .84%, respectively; adjusted odds ratio [AOR] 1.72; P = .0002), a higher readmission rate (2.14% versus 1.64%, respectively; AOR 1.40; P = 0.0034), and a higher reoperation rate (.61% versus .27%, respectively; AOR 2.35; P < .0001). There was no difference in mortality (.08% versus .04%, respectively; AOR 2.62; P = .0923).

Conclusion: Same-day discharge after LSG is associated with increased complications, readmissions, and reoperations compared with POD1 discharge. Further studies are needed to examine objective criteria for safe same-day discharge after LSG.

Keywords: Ambulatory surgery; Bariatric surgery; Day-case surgery; Enhanced recovery after surgery; Laparoscopic sleeve gastrectomy; Outcomes; Outpatient surgery; Same-day discharge.