Obesity is a major global health concern, due to its association with multiple chronic diseases and increased mortality risk. Conventional treatment approaches, including lifestyle modification and pharmacotherapy, have limited long-term effectiveness in achieving sustained weight loss. Metabolic and bariatric surgery (MBS) has emerged as the most effective intervention for severe obesity, and the postoperative length of stay following these procedures has progressively shortened over the past decade.1
‘With careful patient screening, standardised perioperative care and well-defined discharge protocols, SDD can deliver outcomes comparable to inpatient care, while reducing costs and improving patient experience.’
Same-day discharge (SDD) following MBS has gained increasing attention, particularly for the two most common procedures: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The majority of published studies originate from the USA and predominantly involve SG. High success rates for SDD in both SG and RYGB have been demonstrated through recent meta-analyses and systematic review, with acceptable morbidity and reoperation rates.1 Importantly, readmission rates remain low: typically under 4%. Among readmissions following SDD SG, nausea and vomiting are the most frequent causes, emphasising the importance of optimal perioperative anaesthesia and robust postoperative management protocols.2,3
PATIENT SELECTION
Appropriate patient selection is crucial for ensuring the safety and success of an SDD approach. Most studies had similar inclusion criteria, typically involving thresholds for age, body mass index (BMI) and ASA (American Society of Anesthesiologists) classification. A large cohort study of SDD SG identified female sex, gastroesophageal reflux disease, renal insufficiency and intraoperative drain placement as independent predictors of 30-day readmission.2 In addition, data from the Bariatric Outcomes Longitudinal Database assessing SDD for RYGB demonstrated that male sex, age >50 years, BMI 50–70kg/m2 and the presence of more than five co-morbidities were independent risk factors for mortality for this cohort.4
DISCHARGE CRITERIA
Discharge criteria and protocols were described in few studies, with an emphasis on established discharge guidelines, assessing parameters such as consciousness, oxygenation, circulation, respiration and mobility, along with oral intake, urine output, pain and nausea control.5 A common criterion was perioperative intravenous hydration to facilitate recovery and minimise readmission risk,6 with other studies incorporating blood testing, including a haemoglobin check.3,7
ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY
'As pressures build on healthcare systems, SDD represents a critical step in modern bariatric practice, combining safety, efficiency and patient-centred care.'
Understandably, surgeons have been more cautious about applying SDD to RYGB, as it is technically more complex than SG, involving two gastrointestinal anastomoses and consequently longer operative times and a higher potential for perioperative complications. Despite these concerns, studies report near 100% SDD success rates for RYGB, with readmission rates under 4%, comparable to those observed with standard inpatient care.1 Furthermore, comparative studies between SDD and inpatient RYGB revealed no significant differences in readmission rates.8 Notably, nausea and vomiting were not significant causes for readmission following SDD RYGB, contrasting with findings for SG.
COST CONSIDERATIONS
Cost considerations play an important role in improving access to MBS. However, data directly comparing the economic impact of SDD versus inpatient pathways remain limited. A single-centre prospective economic analysis by Ignat et al.9 compared total costs (spanning preoperative evaluation to one-month postoperative follow up) between SDD and conventional inpatient bariatric surgery (SG and RYGB). The study demonstrated a 14.4% overall cost reduction in the SDD group, highlighting the potential financial benefits of this approach, without compromising patient safety or outcomes. Data on patient experience are not yet published but will provide an insight into patient views and expectations of their care pathways.
IN SUMMARY
SDD after MBS (particularly SG and, increasingly, RYGB) has proven to be a safe, efficient and cost-effective approach in appropriately selected patients. With careful patient screening, standardised perioperative care and well-defined discharge protocols, SDD can deliver outcomes comparable to inpatient care, while reducing costs and improving patient experience. As pressures build on healthcare systems, SDD represents a critical step in modern bariatric practice, combining safety, efficiency and patient-centred care.
SARA JAMEL, PATRICIA ORTEGA AND SANJAY PURKAYASTHA
Imperial College Healthcare NHS Trust, London
REFERENCES
1. Vanetta C et al. 2023 Surgery for Obesity & Related Diseases https://doi.org/10.1016/j.soard.2022.09.004.
2. Dreifuss NH et al. 2022 Obesity Surgery https://doi.org/10.1007/s11695-022-05919-y.
3. Lalezari S et al. 2018 Surgery for Obesity & Related Diseases https://doi.org/10.1016/j.soard.2018.02.015.
4. Morton JM et al. 2014 Annals of Surgery https://doi.org/10.1097/sla.0000000000000227.
5. Aldrete JA 1995 Journal of Clinical Anesthesia https://doi.org/10.1016/0952-8180(94)00001-k.
6. Surve A et al. 2018 Surgery for Obesity & Related Diseases https://doi.org/10.1016/j.soard.2018.05.027.
7. Nijland LMG et al. 2021 Obesity Surgery https://doi.org/10.1007/s11695-021-05384-z.
8. Inaba CS et al. 2018 Journal of the American College of Surgeons https://doi.org/10.1016/j.jamcollsurg.2018.01.049.
9. Ignat M et al. 2022 Obesity Surgery https://doi.org/10.1007/s11695-022-06144-3.
