Feasibility of Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass Using Remote Monitoring

Abstract

Background Shortening of hospital stay to 1 night has not affected the short-term safety of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). Whether the RYGB is feasible in an ambulatory setting (same-day discharge) without overnight hospital stay remains to be answered. We aimed to evaluate the feasibility of same-day discharge after laparoscopic Roux-en-Y gastric bypass (RYGB) using additional live video consultation and remote monitoring. Same-day discharge (SDD) was defined as surgery without postoperative overnight hospital stay. Methods This was a single-center prospective feasibility study in a selected group of patients undergoing a RYGB. Fifty patients undergoing a primary RYGB were selected and potentially treated following the SDD protocol. After SDD discharge patients were remotely monitored after surgery for 48 h using a medical device measuring vital signs three times a day. Video consultations were performed by a doctor twice a day for 2 postoperative days. Primary outcome was the success rate (%) of SDD. Secondary outcomes were emergency room presentations, readmissions, early complications (<30 days), and patient satisfaction. Results A total of 50 patients were selected for the SDD treatment protocol between June 2020 and November 2020. An SDD success rate of 88 % (44/50 patients) was achieved. Five patients (10%) presented at the emergency room, 2 of whom (4%) were readmitted because of a complication within 30 days after surgery. Overall, patients who followed the SDD protocol reported high satisfaction scores. Conclusion A RYGB with SDD can be considered feasible using remote monitoring for a selected group of patients. Graphical abstract

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

“…More recently, several centers started to perform major bariatric operations (RYGB and sleeve gastrectomy (SG)) on a day-case/ambulatory basis with encouraging outcomes [ 14 – 19 ]. Same-day discharge might reduce costs and nosocomial infections, and improve patients’ satisfaction [ 21 , 22 ].…”

“…A couple of single-center series reported that SDD-RYGG is safe and feasible in selected patients [ 17 , 19 ]. For instance, Leepalao et al performed a retrospective analysis of 362 patients who underwent SDD-RYGB and found no mortalities, 98.1% SDD success, 3.6% readmission, 2.5% complication, and 2.5% reoperation rates [ 17 ].…”

Fighting the obesity pandemic during the COVID-19 pandemic

“…These studies show no increase in mortality with same-day discharge of LSG with mixed results on increased morbidity with POD 0 discharge versus POD 1. To our knowledge, there are only four other studies that look at discharging LRYGB on POD 0 [ 20 – 23 ], and they report a mixed safety profile for same-day discharge of LRYGB. In 2014, Morton et al [ 20 ] reviewed the Bariatric Outcomes Longitudinal Database to determine the safety of same-day discharge of LRYGB, and Inaba et al [ 21 ] used the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database to evaluate the safety of same-day discharge after LRYGB.…”

“…Two recent studies published in 2019 and 2021 by Leepalao et al [ 22 ] and Nijland et al [ 23 ] show that there is no increase in morbidity with same-day discharge after LRYGB. Leepalao et al examined 362 patients and found a readmission rate of 3.59%, and a complication rate of 0.24%, and had 0% mortality [ 22 ].…”

What Is an ‘OR’ in 2030: Anesthesia Beyond the Operating Room

“…In patients undergoing laparoscopic Roux-en-Y gastric bypass surgery, Nijland et al demonstrated an 88% success rate in same-day discharge by utilizing these monitoring techniques. 8 Same-day discharge patients were remotely monitored for 48 hours after surgery using a medical device measuring vital signs three times a day. Video consultations were performed by a doctor twice a day for two postoperative days.…”