Procedures performed in ambulatory surgical centers (ASC) can provide several advantages
over hospital-based surgery. Understandably, concerns have been raised regarding “high
acuity” cases in the ASC setting. Recently the Metabolic and Bariatric Surgery Accreditation
and Quality Improvement Program (MBSAQIP) presented protocols for ASCs to follow,
requiring them to perform only “low acuity” cases to be compliant with accreditation.
Assess the safety and efficacy of outpatient sleeve gastrectomy (SG) on the “high
acuity patient” in a free-standing ASC.
Free-standing ASC, Eviva Bariatrics, Seattle, Washington.
Data were collected retrospectively for all patients who underwent sleeve gastrectomy
from January 1, 2013 to December 31, 2015, n = 1112. Of those patients, 120 were classified
as “high acuity.”
Mean age was 51.7 years (24–73), mean body mass index was 42.4 (26.2–65.9). Mean operative
time was 91 minutes. Five patients (4.2%) were readmitted within 30 days. Causes of
re-admission were portal vein thrombosis (n = 2), intra-abdominal abscess (n = 1),
infected hematoma (n = 1), and postoperative bleeding (n = 1). One patient (0.83%)
was transferred from the ASC to a nearby hospital due to a postoperative bleed. One
patient (0.83%) had a re-operation to evacuate a hematoma. One patient had a re-operation
to wash out an infected hematoma. There were 0 confirmed staple line leaks. There
were no open conversions and no deaths within 30 days or at 1 year. Follow-up was
83% (n = 100) at 6 months, and 65.0% at 1 year (n = 78).
Criteria such as age, body mass index, or prior bariatric surgery did not reflect
worse outcomes in a specialized ASC. With experienced surgeons, appropriate protocols,
and a consistent operative team, SG can be performed safely in a free-standing ASC
on select “high acuity” patients.