Same-day discharge sleeve gastrectomy: Is inpatient care worth it?

Same-day discharge after sleeve gastrectomy for obesity has been shown to be safe; however, the cost effectiveness of this approach is unclear. We compared 90-day charges associated with same-day discharge versus overnight stay sleeve gastrectomy.

We queried the Health Care Utilization Project State Inpatient, Ambulatory Surgery, and Emergency Department databases for Florida, Georgia, Maryland, and Wisconsin. Adults undergoing sleeve gastrectomy from 2017 to 2018 were identified. Total health care charges were aggregated over 90 days. Multivariable linear and logistic regression identified factors associated with charges and readmission. Overnight stay sleeve gastrectomy patients were 4:1 propensity matched to same-day discharge sleeve gastrectomy patients.

Thirty-eight thousand four hundred forty-six patients met inclusion criteria: 2,105 (5.5%) same-day discharge and 36,341 (94.5%) overnight stay sleeve gastrectomies were identified. Same-day discharge was associated with decreased 90-day charges (charge ratio, 0.76; 95% confidence interval, 0.73-0.78; P < .001) and readmission (odds ratio, 0.77; 95% confidence interval, 0.60-0.98; P = .035) compared with overnight stay sleeve gastrectomy. Patients with higher comorbidity burdens had increased charges (charge ratio, 1.73; 95% confidence interval, 1.68-1.78; P < .001) and readmission rates (odds ratio, 1.91; 95% confidence interval, 1.72-2.13; P < .001). After matching, cohorts had similar rates of readmission (4.2% vs 5.2%, P = .051), emergency department visits (14% vs 14%, P > .99), postoperative visits (21% vs 22%, P = .73), and postoperative endoscopy rates (2.1% vs 2.1%, P = .99). Index charges ($47,685 ± 1,029 vs $59,648 ± 704; P < .001) and total 90-day charges ($53,132 ± 1,436 vs $66,886 ± 948; P < .001) were lower for same-day discharge.

In appropriately selected patients, same-day discharge after sleeve gastrectomy is associated with lower 90-day health care charges and comparable clinical outcomes as overnight stay sleeve gastrectomy.