Is same-day discharge after bariatric surgery safe? A national MBSAQIP analysis

Same-day discharge (SDD) following bariatric surgery has gained interest due to potential cost savings, but concerns remain regarding its safety compared with short postoperative observation.

To evaluate the association between discharge timing and 30-day mortality and serious postoperative complications following bariatric surgery.

United States METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database (2015-2019) was analyzed. Adult patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were included. Discharge timing was categorized as same-day (postoperative day 0), outpatient (postoperative day 1), or inpatient (>1 day). Patient characteristics were compared using Kruskal-Wallis and χ2 tests. Multivariable logistic regression adjusted for demographic, clinical, and operative factors evaluated associations between discharge timing, 30-day mortality, and serious complications (Clavien-Dindo grade ≥ III).

Across both RYGB and SG cohorts, outpatient discharge was associated with significantly lower odds of mortality and serious complications compared with SDD. After adjustment, outpatient discharge demonstrated a 75% reduction in mortality and a 60% reduction in serious complications for RYGB (P ≤ .0005), and a 58% reduction in mortality and 35% reduction in serious complications for SG (P ≤ .002). Compared with SDD, inpatient discharge was associated with lower mortality after RYGB but showed no mortality difference after SG, while SG inpatients had higher odds of serious complications.

SDD after bariatric surgery was associated with higher mortality and serious complication rates compared with next-day outpatient discharge. Brief postoperative observation may provide a safer risk profile across bariatric procedures.