Same-Day Discharge Sleeve Gastrectomy at a Military Treatment Facility: Protocol and Initial Outcomes

The laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric surgery. Due to its relative safety and low complication rate, it has been more commonly performed as an ambulatory surgery. "Outpatient" or discharge from postanesthesia care unit within 23 h has been well studied in the civilian sector and has been shown to result in reduced costs, hospital-acquired infections, and improved patient satisfaction. Although there are numerous benefits to outpatient LSG, the military health system has been slow to adopt this practice. This study represents the first and only series on same day (SD)-LSG within the military and demonstrates our protocol, experience, and initial outcomes at Madigan Army Medical Center.

Twenty-eight patients underwent SD-LSG between April 28, 2021, and May 22, 2023. Before initiation of the SD-LSG, a multidisciplinary protocol to include all phases of care (surgical clinic, operating room, and the postanesthesia care unit) was created. Data were prospectively collected. Exclusion criteria included patients with BMI >50 kg/m², expected operative time >2 h, nonambulatory, intermediate or high cardiac risk, severe obstructive sleep apnea, immunocompromised, or dialysis dependent. The primary outcomes included mortality, complications, and readmission rates. The secondary outcomes included patient satisfaction, operating room and postanesthesia care unit times, pIV patency rates, and percent excess body weight loss.

Our patient demographics were similar to national demographics for all LSG in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program reported for the same period, with the exception of being slightly younger. During the study period in our institution, 76 LSG were performed in total, 46 of which were performed by participating surgeons and therefore included in the study. Of those included, 28 (61%) were same-day LSG, and 18 (39%) were inpatient LSG, as they did not qualify for the same-day protocol. Of the same-day group, none required unplanned postoperative admission. We had no mortality, reoperations, or readmissions. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data for the same time frame showed 2.4% readmissions, 0.4% reoperations, and 0.1% mortality. We had one Clavien-Dindo class 2 complication of postoperative hematoma requiring transfusion (3.6%, n = 1/28), which is comparable to reported minor complication rates for LSG, ranging from 2.5% to 5.8% in the literature.

SD-LSG can be a safe and feasible practice in the military health system, helping to offload the inpatient census. Initiating this protocol requires careful patient selection, a multidisciplinary approach, and appropriate coordination with all phases of patient care. SD-LSG has comparable risks to inpatient LSG while reducing inpatient hospital care burden and improving patient satisfaction.