Same-day discharge vs. inpatient stay in laparoscopic sleeve gastrectomy: a systematic review and meta-analysis.

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric operation globally. Same-day discharge (SDD) LSG is now becoming increasingly common, with many studies reporting this to be safe when compared to a postoperative inpatient (IP) stay. This systematic review and meta-analysis aims to compare outcomes between patients undergoing LSG as SDD and IP.

Materials and methods: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. A search strategy was developed and used to search the MEDLINE/Pubmed, Cochrane library, EMBASE, and Scopus databases. The primary outcome measures were mortality, emergency room (ER) visits, readmission, and reoperation. Secondary outcomes were morbidity, postoperative leak, length of stay of rehospitalization, cancellation of planned day-case, reasons for cancellations, postoperative pulmonary embolism (PE), and postoperative deep vein thrombosis (DVT). Pooled odds ratios with 95% confidence intervals were calculated for outcomes using fixed- or random-effects models.

Results: 11 studies were identified and included in the qualitative analysis, with a total of 138 001 patients in the SDD (25 069) or IP (112 932) groups. Seven studies with a total of 3737 patients were included in the meta-analysis. The number of ER visits was significantly higher in the IP group compared to the SDD group (OR = 1.52, 95% CI: 1.09-2.13, P = 0.01). There was no significant difference in the readmission rate (OR = 1.48, 95% CI: 0.80-2.76, P = 0.21) or the reoperation rate (OR = 0.62, 95% CI: 0.12-3.25, P = 0.58). Mortality and morbidity were low in all studies where they were reported and were largely similar across the groups.

Conclusion: Overall, SDD LSG when compared to IP LSG is safe and not associated with higher mortality, morbidity, readmission, reoperation rates, or ER visits.