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

Published:September 10, 2022DOI:https://doi.org/10.1016/j.soard.2022.09.004

      Highlights

      • Fourteen studies with 33,403 patients who underwent SDD SG or RYGB were analyzed.
      • SDD success rates were high for both SG (99%) and RYGB (88%–98%).
      • Morbidity and readmission rates were comparable to inpatient management.
      • Standardization of SDD selection criteria and perioperative protocols is needed.

      Abstract

      Length of stay after bariatric surgery has progressively shortened. Same-day discharge (SDD) has been reported for the 2 most common bariatric procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to evaluate the safety and success of SDD following SG and RYGB. Systematic literature search on SDD after bariatric surgery was conducted in Medline, Cochrane library, Google Scholar, and Embase. SDD was defined as discharging the patient during the day of the bariatric operation, without an overnight stay. The primary outcomes of interest were successful SDD, readmission, and morbidity rates. The secondary endpoints included reoperation and mortality rates. A proportion meta-analysis was performed to assess the outcomes of interest. A total of 14 studies with 33,403 patients who underwent SDD SG (32,165) or RYGB (1238) were included in the qualitative synthesis. Seven studies with 5000 patients who underwent SDD SG were included in the quantitative analysis, and pooled proportions (PPs) were calculated for the outcomes of interest. The SDD success rate was 63%–100% (PP: 99%) after SG and 88%–98.1% after RYGB. The readmission rate ranged from .6% to 20.8% (PP: 4%) after SDD SG and 2.4%–4% after SDD RYGB. Overall morbidity, reoperation, and mortality were 1.1%–10% (PP:4%), .3%–2.1% (PP: 1%), and 0%–.1% (PP: 0%), respectively, for SDD SG, and 2.5%–4%,1.9%–2.5%, and 0%–.9%, respectively, for SDD RYGB. SDD after SG seems feasible and safe. The outcomes of SDDRYGB seem promising, but the evidenceis stilllimitedto draw definitive conclusions. Selection criteria and perioperative protocolsmust be standardized to adequately introduce this practice.

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      Linked Article

      • Comment on: Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis
        Surgery for Obesity and Related Diseases
        • Preview
          Once believed unattainable, same-day-discharge (SDD) surgery for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) is now a reality. The capabilities to perform such operations on an outpatient basis have improved access to care in certain environments when healthcare systems may be strapped for resources. The challenges posed during the first 2 years of the COVID-19 pandemic have hastened the utilization of this strategy as outpatient surgical centers have often been the only option when hospital beds have been scarce [1].
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      • Comment on: Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysis
        Surgery for Obesity and Related Diseases
        • Preview
          In this issue, Vanetta et al. [1] evaluate the safety and success of same-day discharge (SDD) following the 2 most commonly performed bariatric procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The authors describe qualitatively the results of 33,403 patients across 14 studies who underwent SDD after SG (n = 32,165) or after RYGB (n = 1238) and perform a quantitative meta-analysis of 5000 patients across 7 studies who underwent SDD following SG. Successful SDD, readmission, and morbidity rates were primary outcomes, and reoperation and mortality rates were secondary outcomes.
        • Full-Text
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