Safety of Same-Day Discharge after Sleeve Gastrectomy in Adults 65 Years and Older

This study compared outcomes of same-day discharge vs next-day discharge after minimally invasive sleeve gastrectomy (SG) in adults aged 65 years and older.

A retrospective analysis was performed using 2022 data from the MBSAQIP. Patients discharged on postoperative day (POD) 0 vs POD 1 after SG were compared. Univariate analyses assessed demographics, comorbidities, and 30-day outcomes. Propensity score matching minimized demographic confounding, and regression adjustment addressed residual imbalance. Significance was set at a p value of <0.05.

A total of 4,609 patients were included in the study. Of these, 310 (6.7%) were discharged on POD 0 and 4,299 (93%) on POD 1 after SG. POD 0 patients were younger in age (67.8 ± 2.7 vs 68.4 ± 3, p = 0.004), more likely to be women (81.6% vs 71.7%, p = 0.0002), and had a lower BMI compared with POD 1 patients (41.4 ± 6.5 vs 42.6 ± 6.4 kg/m 2 , p = 0.0003). Despite a significantly lower rate of hypertension, obstructive sleep apnea, and COPD in POD 0 patients, they were more likely to experience wound disruption (p < 0.001), acute renal failure requiring dialysis (p = 0.015), and administration of outpatient IV fluids (p = 0.008). After propensity score matching, POD 0 patients were still more likely to require the administration of outpatient IV fluids (4.8% vs 0.97%, p = 0.005).

Same-day discharge SG for patients aged 65 years and older is associated with increased 30-day complications despite fewer preoperative obesity-associated comorbidities. Older patients may be more sensitive to dehydration events, and consideration should be given to continue inpatient monitoring after SG for these patients.