Gastric sleeve resection as day-case surgery: what affects the discharge time?

Abstract

Background: Sleeve gastrectomy (SG), with its short operating time, is possible to perform as same-day surgery, with the most common reason for requiring overnight hospital stay being post-operative nausea and vomiting. Objective: To demonstrate the feasibility and safety of SG as same-day surgery with regards to complication rate. Additionally, the study aimed to evaluate factors determining the duration of hospital stay, such as type of anesthesia, time of procedure, degree of postoperative nausea and pain, American Society of Anesthesiologists (ASA) score or previous abdominal surgery. Setting: Non-academic primary referral center. Method: A sub-study of a single-center, double blind, randomized controlled trial. Patients included in this study underwent SG and were randomized into one of the two types of anesthesia; Total intravenous anesthesia (TIVA) with propofol, or desflurane. Primary endpoint was the number of patients discharged the same day as surgery. Secondary endpoints were unplanned telephone calls, readmission rate and complication rate. Time of procedure was registered by the staff at the operation theatre. Visual analogue scales (VAS) score estimating patients' intensity of pain and nausea were completed at the postoperative (PO) unit, surgical ward, and 24-48 hours post-operatively. Results: Ninety-three patients were included in the study. Fifty-nine (63%) were discharged the same day as surgery (32 desflurane and 27 TIVA), 30 patients (32%) were discharged one 2 day following surgery, and four patients (4%) were discharged after more than two days (15 desflurane and 19 TIVA). The most common reasons for prolonged stay were pain, nausea and fatigue. Statistical analyses showed no association between day of discharge and the type of anesthesia, time of the procedure, degree of postoperative nausea and vomiting (PONV), pain intensity, ASA score, or previous abdominal surgery. Conclusion: Same-day surgery is feasible and safe in terms of low complication rate. The type of anesthesia, time of procedure, degree of PONV and pain, ASA score and previous abdominal surgery does not appear to affect length of hospital stay.

Influencing factors for delayed discharge following day surgery: A retrospective case–control study

“…Moreover, Tenconi et al (2008) found that patients' doubts about day surgery procedures or their insecurity feelings of the proposal of discharge within 24 hr were also important factors for delayed discharge. Conversely, Aftab et al (2019) reported that the anaesthesia type, procedure time, PONV and pain had no effects on delayed discharge in gastric sleeve resection cases undergoing day surgery. Although these studies above reported the risk factors for delayed discharge in day surgery cases, the heterogenicities such as varied definitions of delayed discharge and different surgery procedures contributed to the controversial results.…”

Enhanced recovery after bariatric surgery: an Italian consensus statement

“…Discharge on the day of surgery was reported as feasible in selected patients [ 190 – 192 ]. However, there was some disagreement around the safety of same-day discharge [ 193 , 194 ].…”

The effects of fentanyl, oxycodone, and butorphanol on gastrointestinal function in patients undergoing laparoscopic hysterectomy: a prospective, double-blind, randomized controlled trial

“…Third, total intravenous anesthesia was administered throughout the surgery. So, the effect of inhalation anesthesia on gastrointestinal function was ruled out [7,28]. Forth, we found that fentanyl, oxycodone, and butorphanol allowed for equivalent analgesia.…”