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

Aryaie, Amir; Reddy, Vamsi; Dattilo, Zachary; Janik, Michał

doi:10.1016/j.soard.2020.08.039

Cited by 29 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study, patients undergoing SDD-SG had a similar incidence of 90-day complications compared to other eligible patients who underwent SDA-SG (2% vs. 7%). This is in contrast to findings from other large multicenter studies using data from the 2015–2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database that reported significantly higher 30-day morbidity including readmission and reintervention after SDD-SG compared to patients discharged on POD 1 [ 16 , 27 ]. Our observation on similar 90-day morbidity between both groups is explained in part by the fact that in our prospective study, we compared outcomes after SDD-SG to a similarly selected group of patients who opted for SDA-SG, with only 72% of patients meeting the eligibility criteria for SDD.…”

Section: Discussioncontrasting

confidence: 96%

“…Hence, SG is an ideal bariatric procedure to evaluate the SDD approach. However, most studies on SDD-SG either lack clearly defined selection and discharge criteria or include an overnight stay at a medical facility that cannot differentiate between those patients who truly underwent an outpatient surgery versus those who had a same-day admission (SDA) and were discharged within 24-h.[ 15 , 16 ] Thus, the objective of our prospective pilot study was to assess the feasibility of a SDD protocol for SG, and estimate the effect on LOS, emergency department (ED) visits and 90-day morbidity.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Ambulatory sleeve gastrectomy: a prospective feasibility and comparative study of early postoperative morbidity

et al. 2022

View full text Add to dashboard Cite

Background Given its short procedure time and low morbidity, there is enthusiasm to perform sleeve gastrectomy (SG) in an outpatient setting. However, most relevant studies include an overnight stay at a medical facility (≤ 24-h). Hence, we investigated the feasibility and safety of a same-day discharge (SDD) protocol for laparoscopic SG. Methods In a prospective pilot study (02/01/2021–02/28/2022), all patients planned for SG were screened for eligibility. Patients met the inclusion criteria if they were ≤ 65 years old, without major comorbidity, and lived close to the hospital. Postoperatively, patients who met discharge criteria were sent home directly from the recovery room. Patients were called the same night and the next morning. Feasibility was defined as discharge on the day of surgery without emergency department (ED) visit or readmission within 24-h. Secondary outcomes, including 90-day morbidity, were compared to patients who met inclusion criteria but chose a same-day admission (SDA) approach during the same study period. Descriptive statistics are displayed as count (percentage) and median (interquartile range). Results A total of 320 patients were planned for SG during the study period, 229 of whom met eligibility criteria and underwent SG with 56 agreeing to SDD-SG while 173 opted for SDA-SG. Baseline characteristics were all similar between both groups except for obstructive sleep apnea being more prevalent in SDA-SG group (38.2% vs. 16.1%; P < 0.001). Operative characteristics including procedure time were similar between both groups. Successful SDD-SG was achieved in 54(96%) of patients with a median of 6.0(1.0) hours of stay in the recovery room. Ninety-day morbidity was similar between SDD-SG and SDA-SG groups (1.8% vs. 6.9%, respectively; P = 0.196). Conclusion A SDD protocol for laparoscopic SG was feasible and safe in selected patients. Larger studies that evaluate patient reported outcomes and include bypass-type procedures may be needed to guide safe use of ambulatory bariatric surgery.

show abstract

Section: Discussioncontrasting

confidence: 96%

mentioning

confidence: 99%

Ambulatory sleeve gastrectomy: a prospective feasibility and comparative study of early postoperative morbidity

et al. 2022

View full text Add to dashboard Cite

show abstract

“…As described above, our discharge protocol provides liquid diet on postoperative day 3, therefore shorter length of stay cannot be achieved in our department. We are well aware that there is a current discussion on the safety of LSG as a day case surgery [ 34 ], but this management of bariatric surgery does not apply to our hospital due to the absence of an accident and emergency unit.…”

Section: Discussionmentioning

confidence: 99%

Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence

et al. 2021

View full text Add to dashboard Cite

To evaluate whether the learning curve for sleeve gastrectomy could be completed after 50 cases. First 100 patients undergoing LSG under a newly trained laparoscopic surgeon were included in this study and divided into two groups of 50 consecutive patients each. Perioperative outcomes were compared to recently introduced global benchmarks. Short-term weight loss was calculated as Total Weight Loss Percent (%TWL) and complications were classified in accordance with the Clavien–Dindo classification. CUSUM analysis was performed for operative time and hospital stay. Mean preoperative age and BMI were 41.8 ± 10.3 years and 42.9 ± 5.4 kg/m2, respectively. Demographics and rate of patients with previous surgery were comparable preoperatively in the two groups. Mean operative time was 92.1 ± 19.3 min and hospital stay was 3.4 ± 0.6 days as per our standard protocol of discharge. Uneventful postoperative course was recorded in 93% of patients and only one case of staple line leak was registered in the first 50 cases (group 1). No statistical difference in BMI and %TWL was found between the two groups at any time of follow-up. Comparison between two groups showed a significant reduction in hospital stay and operative time after the first 50 LSGs (p < 0.05). LSG can be performed by newly trained surgeons proctored by senior tutors. At least 50 cases are needed to meet global benchmark cut-offs and few more cases may be required to reach the plateau of the learning curve.

show abstract

“…The safety of same-day discharge SG, when compared to conventional hospitalization, has also been analyzed with conflicting results in the literature [17, [20][21][22][23]. Inaba et al analyzed 85,321 SG from the 2015-2016 MBSAQIP database and found that same-day discharge SG was associated with higher overall morbidity (1.3% vs. 0.84%, p = 0.0002), [23].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Readmission After Same-Day Discharge Sleeve Gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis

et al. 2022

View full text Add to dashboard Cite

Background Same-day discharge after sleeve gastrectomy (SG) is gaining popularity. We aimed to determine risk factors associated with readmission in patients who underwent same-day discharge SG. Methods We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for the period 2015-2018. Patients who underwent SG and were discharged the same day of the operation were included in the analysis. Multivariable logistic regression analysis was performed to determine risk factors for readmission. Results A total of 466,270 SG were performed during the study period; 14,624 (3.1%) patients were discharged the same day and were included in the analysis. Mean age was 43.4 (14.7-80) years and 11,718 (80.1%) were female. Mean preoperative BMI was 43.7 ± 7.4 kg/m 2 . Mean operative time was 58.3 ± 32.4 min. Thirty-day reoperation, reintervention, and mortality rates were 0.7%, 0.7%, and 0.1%, respectively. Readmission rates were similar in same-day discharge and inpatient SG (2.9% vs. 3%, p = 0.5). Female sex (OR 1.52, 95% CI 1.15-2.00), preoperative gastroesophageal reflux disease (OR 1.33, 95% CI 1.08-1.64), renal insufficiency (OR 3.06, 95% CI 1.01-9.32), and intraoperative drain placement (OR 1.78, 95% CI 1.37-2.31) were independent risk factors for readmission following same-day discharge SG. Conclusions Same-day discharge SG appears to be safe and is associated with low readmission rates. However, the identification of preoperative and intraoperative variables associated with higher risk of readmission might help defining safer and more effective same-day discharge protocols.

show abstract

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

Cited by 29 publications

References 17 publications

Ambulatory sleeve gastrectomy: a prospective feasibility and comparative study of early postoperative morbidity

Ambulatory sleeve gastrectomy: a prospective feasibility and comparative study of early postoperative morbidity

Learning curve and global benchmark values of laparoscopic sleeve gastrectomy: results of first 100 cases of a newly trained surgeon in an Italian center of excellence

Risk Factors for Readmission After Same-Day Discharge Sleeve Gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis

Contact Info

Product

Resources

About