Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass: a Cohort of 500 Consecutive Patients

Abstract

Introduction There is an increasing demand on hospital capacity worldwide due to the COVID-19 pandemic and local staff shortages. Novel care pathways have to be developed in order to keep bariatric and metabolic surgery maintainable. Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is proved to be feasible and could potentially solve this challenge. The aim of this study was to investigate whether SDD after RYGB is safe for a selected group of patients. Methods In this single-center cohort study, low-risk patients were selected for primary RYGB with intended same-day discharge with remote monitoring. All patients were operated according to ERAS protocol. There were strict criteria on approval upon same-day discharge. It was demanded that patients should contact the hospital in case of any signs of complications. Primary outcome was the rate of successful same-day discharge without readmission within 48 h. Secondary outcomes included short-term complications, emergency department visits, readmissions, and mortality. Results Five hundred patients underwent RYGB with intended SDD, of whom 465 (93.0%) were successfully discharged. Twenty-one patients (4.5%) were readmitted in the first 48 h postoperatively. None of these patients had a severe bleeding. This results in a success rate of 88.8% of SDD without readmission within 48 h. Conclusions Same-day discharge after RYGB is safe, provided that patients are carefully selected and strict discharge criteria are used. It is an effective care pathway to reduce the burden on hospital capacity. Graphical Abstract

Fully ambulatory robotic single anastomosis duodeno-ileal bypass (SADI): 40 consecutive patients in a single tertiary bariatric center

“…Some of the main concerns in ambulatory bariatric surgery are leaks and bleeding. Nonetheless, relatively low complication rates have been reported for RYGB patients with SDD; 0.3% and 0.2% gastrointestinal bleeding and gastro-jejunal leaks, respectively, in one study [ 42 ] and up to 4% in other studies, mostly leaks [ 40 – 44 ]. We recently published data on major morbidity after 2nd stage SADI (without SDD) and the rate of duodenal-ileal anastomotic leaks was 2.7% [ 17 ].…”

The need for standardized perioperative care for patients undergoing bariatric and metabolic surgery in the United Kingdom

“…However, the consensus on the use of ERAS in SDD remains inconclusive. 9,10 The key to a successful implementation of ERAS is dependent on protocol compliance and robust coordination of a multidisciplinary team. 11 However, there is currently limited evidence on the standardization of perioperative care for patients undergoing BMS in the United Kingdom.…”

“…In recent years, several studies have incorporated the ERAS pathway to facilitate same‐day discharge (SDD) for patients undergoing BMS. However, the consensus on the use of ERAS in SDD remains inconclusive 9,10 …”