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.
Keywords
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 accessOne-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:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.BMC Public Health. 2009; 9: 88
- Reduction of major adverse cardiovascular events (MACE) after bariatric surgery in patients with obesity and cardiovascular diseases: a systematic review and meta-analysis.Nutrients. 2021; 13: 3568
- Obesity in America. American Society for Metabolic and Bariatric Surgery.(Available from:)
- Factors associated with long wait times for bariatric surgery.Ann Surg. 2019; 270: 1103-1109
- The effect of the COVID-19 pandemic on bariatric surgery delivery in Edmonton, Alberta: a single-centre experience.Can J Surg. 2021; 64: E307-E309
- Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.Ann Surg. 2000; 232: 515-529
- Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center.Surg Obes Relat Dis. 2016; 12: 119-126
- Day-case laparoscopic fundoplication for gastro-oesophageal reflux disease.Br J Surg. 2000; 87: 1708-1711
- Day-case laparoscopic cholecystectomy.Saudi Med J. 2015; 36: 46-51
- Short-term outcomes of ambulatory colectomy for 157 consecutive patients.Ann Surg. 2019; 270: 317-321
- Minor laparoscopic liver resection as day-case surgery (without overnight hospitalisation): a pilot study.Surg Endosc. 2019; 33: 261-271
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6: e1000097
- Methodological index for non-randomized studies (minors): development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- One-day surgery laparoscopic sleeve gastrectomy: 96 patients at a Menoufia University Hospital.Egypt J Surg. 2018; 37: 419
- Risk factors for readmission after same-day discharge sleeve gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database analysis.Obes Surg. 2022; 32: 962-969
- Does the future of laparoscopic sleeve gastrectomy lie in the outpatient surgery center? A retrospective study of the safety of 3162 outpatient sleeve gastrectomies.Surg Obes Relat Dis. 2018; 14: 1442-1447
- Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: first 250 cases.Surg Obes Relat Dis. 2014; 10: 101-105
- How safe is same-day discharge after laparoscopic sleeve gastrectomy?.Surg Obes Relat Dis. 2018; 14: 1448-1453
- Safety of same-day discharge after laparoscopic sleeve gastrectomy: propensity score-matched analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program registry.Surg Obes Relat Dis. 2021; 17: 46-53
- Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events?.Ann Surg. 2014; 259: 286-292
- Same-day discharge after laparoscopic Roux-en-Y gastric bypass: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.J Am Coll Surg. 2018; 226: 868-873
- Same-day discharge on laparoscopic Roux-en-Y gastric bypass patients: an outcomes review.Surg Endosc. 2020; 34: 3614-3617
- Fully ambulatory laparoscopic sleeve gastrectomy: 328 consecutive patients in a single tertiary bariatric center.Obes Surg. 2016; 26: 1429-1435
- Gastric sleeve resection as day-case surgery: what affects the discharge time?.Surg Obes Relat Dis. 2019; 15: 2018-2024
- Laparoscopic sleeve gastrectomy as day-case surgery: a case-matched study.Surg Obes Relat Dis. 2019; 15: 534-545
- Feasibility of same-day discharge after laparoscopic Roux-en-Y gastric bypass using remote monitoring.Obes Surg. 2021; 31: 2851-2858
- Laparoscopic sleeve gastrectomy as a viable option for an ambulatory surgical procedure: our 52-month experience.Surg Obes Relat Dis. 2018; 14: 748-750
- The post-anesthesia recovery score revisited.J Clin Anesth. 1995; 7: 89-91
- Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity.Ann Surg. 2007; 246 (discussion 583–4): 578-582
- Failure of the obesity surgery mortality risk score (OS-MRS) to predict postoperative complications after bariatric surgery. A single-center series and systematic review.Obes Surg. 2017; 27: 1423-1429
- Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome.Obes Surg. 2004; 14: 1042-1050
- Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program.Surg Obes Relat Dis. 2015; 11: 288-294
- Early hospital readmission after bariatric surgery.Surg Endosc. 2016; 30: 2231-2238
- 30-day readmissions after sleeve gastrectomy versus Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2016; 12: 991-996
- Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.Surg Obes Relat Dis. 2018; 14: 545-551
- Safety and efficacy of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis.J Eval Clin Pract. 2020; 26: 290-298
- Thirty-day readmission rate using an outpatient infusion pathway after laparoscopic Roux-en-Y gastric bypass.Am Surg. 2018; 84: 1429-1432
- Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies.Obes Surg. 2015; 25: 19-26
- Laparoscopic sleeve gastrectomy as day-case surgery: a review of the literature.Surg Obes Relat Dis. 2019; 15: 1211-1217
- Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences.Surg Endosc. 2019; 33: 272-280
- The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.JAMA Surg. 2014; 149: 275-287
- Ambulatory bariatric surgery: does it really lead to higher rates of adverse events?.Surg Obes Relat Dis. 2020; 16: 1713-1720
- A cost analysis of healthcare episodes including day-case bariatric surgery (Roux-en-Y gastric bypass and sleeve gastrectomy) versus inpatient surgery.Obes Surg. 2022; 32: 2504-2511
- What are the real procedural costs of bariatric surgery? A systematic literature review of published cost analyses.Obes Surg. 2017; 27: 2179-2192
- Ambulatory surgery for sleeve gastrectomy: terminology and concept.Surg Obes Relat Dis. 2017; 13: 1121-1122
- Quality of MBSAQIP data: bad luck, or lack of QA plan?.Surg Endosc. 2020; 34: 973-980
Article info
Publication history
Published online: September 10, 2022
Accepted:
September 5,
2022
Received:
June 10,
2022
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysisSurgery for Obesity and Related DiseasesVol. 19Issue 3
- PreviewOnce 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].
- Full-Text
- Preview
- Comment on: Outcomes of same-day discharge sleeve gastrectomy and Roux-en-Y gastric bypass: a systematic review and meta-analysisSurgery for Obesity and Related DiseasesVol. 19Issue 3
- PreviewIn 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
- Preview
