Is Same-Day Discharge After Roux-en-Y Gastric Bypass Safe? A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis

Nicolas H Dreifuss; Carolina Vanetta; Francisco Schlottmann; Antonio Cubisino; Alberto Mangano; Carolina Baz; Francesco M Bianco; Antonio Gangemi; Chandra Hassan; Mario A Masrur

doi:10.1007/s11695-022-06303-6

Is Same-Day Discharge After Roux-en-Y Gastric Bypass Safe? A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis

Obes Surg. 2022 Dec;32(12):3900-3907. doi: 10.1007/s11695-022-06303-6. Epub 2022 Oct 4.

Affiliations

¹ Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA. dreifuss@uic.edu.
² Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.

Abstract

Purpose: Same-day discharge (SDD) after bariatric surgery is gaining popularity. We aimed to analyze the safety of SDD after Roux-en-Y gastric bypass (RYGB) and compare its outcomes to inpatients discharged on postoperative days 1-2.

Materials and methods: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the period 2015-2020. Patients who underwent primary laparoscopic RYGB and were discharged the same day of the operation (SDD-RYGB) and inpatients discharged on postoperative days 1-2 (In-RYGB) were compared. Primary outcomes of interest were overall morbidity, serious morbidity, readmission, reoperation, intervention, and mortality rates.

Results: A total of 167,188 patients were included; 2156 (1.3%) SDD-RYGB and 165,032 (98.7%) In-RYGB. Mean age (SDD-RYGB: 44.5 vs. In-RYGB: 44.6 years), proportion of females (SDD-RYGB: 81.4% vs. In-RYGB: 80.6%), and mean body mass index (SDD-RYGB: 45.8 vs. In-RYGB: 45.9 kg/m²) were similar between groups. Overall morbidity (SDD-RYGB: 11.3% vs. In-RYGB: 10.2%; OR: 1.2, p = 0.08), serious morbidity (SDD-RYGB: 3.1% vs. In-RYGB: 3%; OR: 1.03, p = 0.81), reoperation (SDD-RYGB: 1.4% vs. In-RYGB: 1.2%; OR: 1.16, p = 0.42), readmission (SDD-RYGB: 4.8% vs. In-RYGB: 4.8%; OR: 1.01, p = 0.89), and mortality (SDD-RYGB: 0.04% vs. In-RYGB: 0.09%; OR: 0.53, p = 0.53) were comparable between groups. SDD-RYGB had lower risk of 30-day interventions (SDD-RYGB: 1.1% vs. In-RYGB: 1.6%; OR: 0.64, p = 0.04) compared to In-RYGB.

Conclusion: Same-day discharge after RYGB seems to be safe and has comparable outcomes to admitted patients. Standardized patient selection criteria and perioperative management protocols are needed to further increase the safety of this practice.

Keywords: Ambulatory gastric bypass; Gastric bypass; Laparoscopic Roux-en-Y gastric bypass; Outpatient bariatric surgery; Same-day discharge.

MeSH terms

Accreditation
Bariatric Surgery* / methods
Female
Gastric Bypass* / methods
Humans
Obesity, Morbid* / surgery
Patient Discharge
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Quality Improvement
Retrospective Studies