Sleeve gastrectomy with same-day discharge: a propensity score-matched analysis of independent predictors of complication.

Introduction: Sleeve gastrectomy (SG) is the most performed bariatric surgery in the US, with a small but growing trend toward outpatient surgery. The aims of this study are to (1) clarify the safety of sleeve gastrectomy with same-day discharge (SDDSG) vs sleeve gastrectomy with inpatient stay (SGIS) utilizing recent MBSAQIP data, (2) identify specific predictors of complication in patients undergoing SDDSG, and (3) understand the relative uptake of SDDSG among the population for whom it would be low-risk.

Methods: This is a retrospective cohort study of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Cases of SDDSG and SGIS were identified in the 2021 and 2022 MBSAQIP. A 2:1 propensity score matching was conducted to control for baseline patient differences. Univariable analyses comparing complication with predictor variables were conducted using chi-square (categorical) or student's t-test (continuous). A stepwise multivariable model was performed to identify predictors of complications in SDDSG.

Results: There were 28,235 cases of SDDSG, of which 406 (1.4%) experienced a complication vs 2.0% of SGIS (p < 0.001). Independent predictors of complication among those undergoing SDDSG included independent functional status (OR 0.24, p = 0.02), smoking status (OR 1.68, p = 0.003), previous cardiac surgery (OR 3.66, p = 0.005), and a history of venous thromboembolism requiring treatment (OR 2.67, p = 0.005). SDDSG accounted for 10.1% of all sleeve gastrectomies (SG), whereas 90.9% of all patients undergoing SG had none of the above risk factors.

Conclusion: SDDSG represents a potential pathway to reduce length of stay and cost for patients seeking bariatric surgery. Uptake remains low among the population at low risk for complication, with possible upside of reduced healthcare cost. When planning for SDDSG, clinicians should exercise patient-centered judgement, with careful consideration of an individual's risk profile.