Ambulatory Discharge of Patients Undergoing Sleeve Gastrectomy Results in Significantly More Adverse Outcomes

Background Same day discharge after sleeve gastrectomy (SDSG) has become more common during the COVID pandemic. Several payers have suggested that they would no longer reimburse for planned inpatient hospital stay for patients undergoing SG. The goal of our study was to determine which, if any, patient groups could safely undergo SDSG. Methods A retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) from 2015-2021 was performed. Multivariable logistic regression analysis was performed using demographics, comorbid disease and participant user file (PUF) year to determine the risk of adverse events within 30 days of SG by postoperative discharge day. Results A total of 702,622 SGs were performed during the study period. 31,308 (4.46%) patients were SDSGs and 409,622 (58.3%) on postoperative day 1 (POD1). From 2015-2019 the mean percentage of cases that were SDSG was 2.9%. The proportion of SDSG increased to 6.3% in 2020 and 9.6% in 2021. Compared to those discharged on POD1, SDSG patients were at increased risk for any complication (OR 1.22 95% CI 1.1-1.36), minor complications (OR 1.17 95% CI 1.03-1.32), major complications (OR 1.36 95% CI 1.15-1.61), readmission (OR 1.09 95% CI 1.00-1.18), and reoperation (OR 1.37 95% CI 1.16-1.62). Other interventions within 30 days were not statistically significant. Conclusion Compared to those discharged on POD1, SDSG patients are at significantly increased risk for all adverse events analyzed. With growing pressure to shorten or eliminate the utilization of hospital beds, identification of appropriate candidates for safe SDSG is crucial.