Safety of gastric bypass with same-day discharge: a propensity score-matched analysis of the Dutch Audit for treatment of Obesity.

Bariatric surgery with same-day discharge (SDD) is becoming increasingly common. Nevertheless, there is limited data available comparing gastric bypass patients with SDD to those with overnight hospitalization. The aim of this study was to investigate the short-term outcomes of gastric bypass with SDD compared to overnight hospitalization in The Netherlands. Retrospective database study with the use of the Dutch national registry. Patients who underwent gastric bypass surgery in 2022 were included and propensity score matching was performed to compare SDD with patients discharged on postoperative days (POD) 1-4. The primary outcome was the occurrence of severe complications within 30 days postoperative. A total of 775 SDD patients were matched with 1550 patients discharged on POD 1-4. The occurrence of severe complications was .9% in both groups (P = 1.000), and there were no significant differences in reoperations or mortality. A significant difference was observed in the readmission rate, with 3.9% in the SDD group compared to 1.6% in the other group (P = .001). A proportionally small, yet statistically significant difference favored the control group regarding anastomotic leakages (.6% versus 0%, P = .004) and unspecified surgical complications (1.4% versus .5%, P = .028). Gastric bypass with SDD is safe, with no increased risk of short-term severe complications, reoperations, or mortality. However, SDD is associated with a higher 30-day readmission rate compared to patients who stay overnight in the hospital after surgery.

Kleipool SC ，Jonkman NH ，van Rutte PWJ ，de Castro SMM ，van Veen RN ，Dutch Audit for Treatment of Obesity (DATO) Research Group ... -  《-》

Perioperative outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass using the MBSAQIP database.

There has been a rising trend of outpatient bariatric surgery, particularly accelerated by the COVID-19 pandemic. The aim of this study was to evaluate the safety and outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass (LRYGB) using the MBSAQIP database. In this retrospective study, the MBSAQIP was queried for patients undergoing non-revisional LRYGB between 2020 and 2021. Two cohorts were established: same-day discharge (SDD; length of stay = 0 days) and next-day discharge (POD1; length of stay = 1 day), with the latter serving as a control group. Univariate analysis and multivariate logistic regression were employed to compare outcomes between cohorts. A total of 48,408 patients underwent LRYGB, with 1,918 (4.0%) SDD and 46,490 (96.0%) POD1. The two cohorts were similar in mean age (SDD 44.2 ± 11.3 years vs POD1 44.0 ± 11.3 years; p = 0.61) and female sex (SDD 83.8% vs POD1 83.1%; p = 0.43). However, the POD1 cohort had a higher preoperative body mass index (45.4 ± 7.3 vs 44.9 ± 7.3 kg/m2; p < 0.01). Preoperative anticoagulation and obstructive sleep apnea were more prevalent in the POD1 group. There was no difference in overall 30-day overall complication rates (SDD 2.0% vs POD1 2.3%; p = 0.51), reintervention, reoperations, mortality, and emergency department visits between the two cohorts. Readmissions were lower in the SDD cohort (2.9% vs 4.0%; p = 0.02), whereas the need for outpatient intravenous hydration was higher in the SDD cohort (6.7% vs 3.6%; p < 0.01). This finding remained significant even after adjustment for confounders. Same-day LRYGB is safe and feasible, with comparable complication rates to next-day discharge. Notably, SDD is associated with lower readmission rate and higher need for outpatient intravenous hydration, possibly reflecting rigorous bariatric protocols and thorough patient follow-up. Further investigations are warranted to elucidate the selection criteria and optimize postoperative care for outpatient LRYGB.

Alam W ，Wisely J ，Nasser H 《-》

Safety and factors associated with early discharge in revisional laparoscopic Roux-en-Y gastric bypass: analysis of the MBSAQIP database.

Improvements in bariatric surgery outcomes have prompted policy initiatives that explore shifting bariatric surgery toward outpatient procedures. While the safety of early discharge after primary laparoscopic Roux-en-Y gastric bypass (LRYGB) has been reported, its safety for revisional LRYGB remains uncertain. Our study aimed to investigate the safety and patient factors associated with early discharge in patients undergoing revisional LRYGB compared with primary LRYGB. We identified adult patients who underwent primary and revisional LRYGB from 2020 to 2022 in the MBSAQIP database. Patients discharged early, i.e., same-day discharge (SDD) and next-day discharge (NDD) were compared to inpatients. Outcomes included 30-day complications (minor = Clavien-Dindo 1-2; major = Clavien-Dindo 3-4), mortality, readmissions, and reoperations. Multivariable logistic regression models adjusting for patient demographics, comorbidities, and operative time were fitted to assess the study outcomes. SDD rate was similar after primary (3,422/137,406; 2.5%) and revisional LRYGB (781/32,721; 2.4%), while NDD rate was higher in primary LRYGB (59.8% vs 54.7%, respectively; p < 0.001). SDD patients had lower odds of major complications compared to inpatients following primary (2% vs 7%, aOR: 0.30, 95%CI 0.24-0.38) and revisional LRYGB (3.7% vs 9.3%, aOR: 0.43, 95%CI 0.29-0.62, respectively). NDD patients had similarly lower odds of morbidity outcomes. ASA Classification IV/V was associated with lower odds of SDD compared to Class I/II (Primary: 0.9% vs. 3%, aOR: 0.61, 95% CI 0.48-0.78; Revisions: 0.9% vs. 3%, aOR: 0.24, 95%CI 0.10-0.55). Early discharge after revisional LRYGB, particularly after an overnight stay, can be accomplished safely in carefully selected patients. However, SDD rates remain low limiting its safety assessment. Further, almost half of the patients stay more than 48 h in the hospital suggesting that policy initiatives toward outpatient management after bariatric surgery may be inappropriate for this patient population.

AbuHasan Q ，Hunt M ，Massoud L ，Burney CP ，Holmstrom AL ，Yuce TK ，Stefanidis D ... -  《-》

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

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. 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. 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. 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.

Dreifuss NH ，Vanetta C ，Schlottmann F ，Cubisino A ，Mangano A ，Baz C ，Bianco FM ，Gangemi A ，Hassan C ，Masrur MA ... -  《-》

Anastomotic metabolic and bariatric surgeries with same-day discharge: 30-day outcomes of a cohort from a high-volume center in Canada.

Deffain A ，Denis R ，Alfaris H ，Ataya K ，Melebari S ，Belliveau M ，Di Palma A ，Garneau PY ，Studer AS ... -  《-》