Laparoscopic Sleeve Gastrectomy as Day Case Surgery vs Conventional Hospitalization: Results of the DAYSLEEVE Randomized Clinical Trial

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric intervention with short operative time and low morbidity and mortality. However, ambulatory sleeve gastrectomy is underutilized.

Objectives

This clinical trial compares feasibility, perioperative outcomes, and weight loss of ambulatory LSG with same-day discharge vs conventional hospitalization with next-day discharge

Setting

Hospital and ambulatory surgery center (ASC)

Methods

Patients who satisfied low acuity criteria were randomized to undergo day case LSG in the ASC with same-day discharge (DC LSG) or LSG with conventional hospitalization and next-day discharge (CH LSG) between December 2018 and 2020. The primary outcomes were 30-day adverse events, hospitalizations, reoperations, and readmissions, and the secondary outcome was weight loss during the first year.

Results

Of 2,541 screened patients, 1,544 patients were randomized in the study. Mean age and body mass index were 31.7 ± 9.1 years vs 31.8 ± 9.2 years and 39.6 ± 5.8 kg/m² vs 40.0 ± 5.7 kg/m² in DC LSG group (n=777) and in CH LSG group (n=777), respectively. Eighteen (2.3%) patients in the DC LSG were transferred to the hospital for overnight stay. Additionally, 13 (1.7%) patients requested additional stay without a medical indication for a total overnight stay rate of 4%. One DC LSG (0.1%) patient was readmitted, and two CH LSG (0.3%) patients stayed for an extra day. Seventeen percent of DC LSG patients had unscheduled consultations during the first postoperative week compared to 6% of the CH LSG patients (p-value <0.001). Those two groups were similar in baseline characteristics. There were no reoperations or mortality in either group, and weight loss results were similar; At one year follow-up, DC LSG %excess weight loss was 87±17% compared to 85±17% in the CH LSG group. The follow-up rate was 100%.

Conclusion

LSG is feasible as a day case procedure with comparable outcomes to conventional hospitalization.