The value of patient selection in same-day discharge implementation: insights from MBSAQIP database

Same-day discharge (SDD) in sleeve gastrectomy (SG) is becoming increasingly common but requires careful patient selection.

To evaluate the risk profile of patients undergoing primary SG with SDD and assess 30-day serious adverse events (SAEs) in SDD and next-day discharge (NDD).

MBSAQIP 2020-2023 (United States).

SDD and NDD patients were categorized as low-risk (LR) [age<65 years, body mass index [BMI] <50 kg/m², and no history of foregut surgery, diabetes, sleep apnea, cardiovascular disease, kidney disease, immunosuppression or thromboembolic events], and high-risk (HR) [patients with at least one of these conditions]. Logistic regression models assessed odds of SAE (i.e., Comprehensive Complication Index ≥26.2) between SDD and NDD based on risk categories and cumulative number of risk factors (RFs).

Forty thousand three hundred eighty-seven SDDs (50.4% LR, 49.6% HR) and 281,718 NDD (41.2% LR, 58.8% HR) were identified. The odds of HR patients experiencing SAE were higher in the SDD versus NDD (odds ratio [OR]: 1.26, confidence interval [CI]: 1.09-1.45, P < .001). Among high-risk SDD, 66.9% patients had one RF, 25.7% had two and 7.4% had ≥ 3. Compared to patients with a single RF, those with 2 RFs and ≥3RFs were more likely to experience SAEs (OR = 1.40 and 2.10, respectively; P < .01).

This study demonstrates that 50% of the SDD SG patients were considered high-risk and 32% had multiple RFs. Performing SG with SDD in high-risk patients is associated with a greater likelihood of SAE. Results warrant implementation of risk stratification models to ensure patient safety while maximizing the benefits of SDD.