High acuity sleeve gastrectomy patients in a free-standing ambulatory surgical center



      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Watkins B.M.
        • Ahroni J.H.
        • Michaelson R.
        • et al.
        Laparoscopic adjustable gastric banding in an ambulatory surgery center.
        Surg Obes Relat Dis. 2008; 4: S56-S62
        • Joshi G.P.
        • Ahmad S.
        • Riad W.
        • Eckert S.
        • Chung F.
        Selection of obese patients undergoing ambulatory surgery.
        Anesth Analg. 2013; 117: 1082-1091
        • Billing P.S.
        • Crouthamel M.R.
        • Oling S.
        • Landerholm R.W.
        Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: first 250 cases.
        Surg Obes Relat Dis. 2014; 10: 101-105
        • Garofalo F.
        • Denis R.
        • Abouzahr O.
        • Garneau P.
        • Pescarus R.
        • Atlas H.
        Fully ambulatory laparoscopic sleeve gastrectomy: 328 consecutive patients in a single tertiary bariatric center.
        Obes Surg. 2015; 26: 1429-1435
        • Garofalo F.
        • Denis R.
        • Pescarus R.
        • Atlas H.
        • Bacon S.L.
        • Garneau P.
        Long-term outcome after laparoscopic sleeve gastrectomy in patients over 65 years old: a retrospective analysis.
        Surg Obes Relat Dis. 2017; 13: 1-6
        • McCarty T.M.
        • Arnold D.T.
        • Lamont J.P.
        • Fisher T.L.
        • Kuhn J.A.
        Optimizing outcomes in bariatric surgery.
        Transactions of the 2005 Meeting of the American Surgical Association. 2005; 123: 188-195
        • Rebibo L.
        • Dhahri A.
        • Badaoui R.
        • Dupont H.
        • Regimbeau J.-M.
        Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization).
        Surg Obes Relat Dis. 2015; 11: 335-342
        • Rickey J.
        • Gersin K.
        • Yang W.
        • Stefanidis D.
        • Kuwada T.
        Early discharge in the bariatric population does not increase post-discharge resource utilization.
        Surg Endosc. 2017; 31: 618-624
        • Abraham A.
        • Ikramuddin S.
        • Jahansouz C.
        • Arafat F.
        • Hevelone N.
        • Leslie D.
        Trends in bariatric surgery: procedure selection, revisional surgeries, and readmissions.
        Obes Surg. 2015; 26: 1371-1377
        • Karamanakos S.N.
        • Vagenas K.
        • Kalfarentzos F.
        • Alexandrides T.K.
        Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy.
        Ann Surg. 2008; 247: 401-407
        • Sippey M.
        • Kasten K.R.
        • Chapman W.H.H.
        • Pories W.J.
        • Spaniolas K.
        30-day readmissions after sleeve gastrectomy versus Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2016; 12: 991-996
        • Awad S.
        • Carter S.
        • Purkayastha S.
        • et al.
        Enhanced recovery after bariatric surgery (ERABS): clinical outcomes from a tertiary referral bariatric centre.
        Obes Surg. 2013; 24: 753-758
        • Kwon P.
        • Marsilio C.
        • Rivera R.
        • et al.
        Safety and effectiveness of sleeve gastrectomy in a community based practice.
        Surg Obes Relat Dis. 2015; 11: S197
        • Aman M.W.
        • Stem M.
        • Schweitzer M.A.
        • Magnuson T.H.
        • Lidor A.O.
        Early hospital readmission after bariatric surgery.
        Surg Endosc. 2015; 30: 2231-2238