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Same-day LSG

Study raises caution over same-day laparoscopic sleeve gastrectomy

Compared to POD1 discharges, POD0 discharges were associated with increased odds of mortality (0.10% vs. 0.02%; AOR 5.70; p=0.032)

A study looking at outcomes of same-day laparoscopic sleeve gastrectomy (LSG) raises some cautions about performing the operation on an outpatient basis. The findings, ‘How safe is same-day discharge for laparoscopic sleeve gastrectomy?’, were presented at ObesityWeek 2017, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity hosted by the American Society for Metabolic and Bariatric Surgery and The Obesity Society.

Dr Ninh T Nguyen

“What a difference a day makes,” said study senior author, Dr Ninh T Nguyen, Chair of the Department of Surgery at the University of California, Irvine School of Medicine. “This study cautions that surgeons performing outpatient gastric sleeve surgery should carefully select only low-risk patients for same day discharge, such as patients with no respiratory issues such as obstructive sleep apnea. The higher mortality rate in the same day discharge group is likely related to respiratory failure events that occurred in an unsupervised and unmonitored setting.”

Researchers from the University of California, Irvine School of Medicine, noted that LSG has been performed by some surgeons on an outpatient basis, but studies on outcomes of same-day LSG are limited. Therefore, they undertook a study to compare outcomes between same-day (POD0) and first-postoperative-day (POD1) discharges for LSG.

They analysed 37,301 gastric sleeve operations for 30-day mortality and complications, and readmission and reoperation rates from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database. Primary outcome measures included 30-day mortality and morbidity. Secondary outcome measures included 30-day readmission and reoperation rates. All outcome measures were risk-adjusted for patient demographic and clinical characteristics using multivariate analysis.

Patients were discharged either the same day of surgery (2,031 patients) or the day after (35,270 patients). Before surgery, patients had an average BMI43. Compared to POD1 discharges, POD0 discharges were associated with increased odds of mortality (0.10% vs. 0.02%; AOR 5.70; p=0.032). There were no statistically significant differences between POD0 vs. POD1 discharges for overall morbidity (0.98% vs. 0.86%), reoperations (0.54% vs. 0.33%), or readmissions (2.41% vs 2.10%).

“Although the overall 30-day mortality associated with LSG is low, same-day discharge after LSG was associated with over five-fold increased odds of death compared to POD1 discharge,” the authors concluded. “Surgeons considering outpatient LSG should carefully select low-risk patients and have a low threshold for admission for any perioperative concerns.”

“Both patients and doctors should approach outpatient bariatric surgery with caution,” said ASMBS past-president, Dr Raul J Rosenthal, Chairman of the Department of General Surgery at Cleveland Clinic Florida, who was not involved in the study. “Bariatric surgery is safer than ever, but discharging patients too soon may have serious consequences. Patients should be evaluated very carefully before they go home.”

The addition authors in this study were Dr Colette Inaba, Christina Y Koh and Sarath Sujatha-Bhaskar.

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