Laparoscopic sleeve gastrectomy as a viable option for an ambulatory surgical procedure: our 52-month experience

Lalezari, Sepehr; Musielak, Matthew; Broun, Lisa A.; Curry, Trace

doi:10.1016/j.soard.2018.02.015

Cited by 47 publications

(30 citation statements)

References 10 publications

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“…Other literature regarding inclusion and exclusion criteria for low acuity centres exists, however almost all of this relates to obesity surgery being performed at privately funded ‘Ambulatory Surgery Centres’ (ASC) either as a day case or 23‐hour admission 26–34 . Transfer rates to a designated hospital were reported as 0%–0.9% 26,33 .…”

Section: Discussionmentioning

confidence: 99%

“…No data are available regarding comorbidities in any of the study populations. Our criteria also appear to include a higher risk population due to more inclusive comorbidity criteria 26,28,33 . In Watkins et al's series on LAGB in an ASC, coronary artery disease or valvular heart disease were contraindications to selection 26 .…”

Section: Discussionmentioning

confidence: 99%

“…They also excluded all patients with previous abdominal surgery 28 . Lalezari's similar series of 821 patients undergoing day‐case LSG excluded patients with a history of renal failure or significant cardiac or pulmonary impairment 33 . Selection bias may also have occurred in some series due the use of a ‘general assessment’ for ASC eligibility, rather than specific criteria 26,31 …”

Section: Discussionmentioning

confidence: 99%

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Efficacy of patient selection criteria for obesity surgery in a non‐high‐dependency unit/intensive care unit facility

Newbold

Craven

Aly

2021

ANZ Journal of Surgery

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Backgrounds Publicly funded obesity surgery remains underfunded in Australia. One barrier to expansion is the perception that perioperative care requires critical care facilities. This study evaluates the effectiveness of patient selection criteria in avoiding unplanned patient transfer and adverse outcomes in obesity surgery performed at a facility without a high‐dependency unit/intensive care unit (HDU/ICU). Methods Retrospective analysis was performed on patients undergoing obesity surgery between January 2017 and March 2020 in a centre with specific screening criteria. Criteria included: body mass index <48 for males and <52 for females with up to three stable comorbidities from a selected list. Revision sleeve or bypass procedures were contraindicated. Primary outcome was patient transfer to our main campus. Secondary outcomes included return to theatre (RTT), readmission and death. Outcomes were compared to laparoscopic cholecystectomies (LC) performed at the same centre. Results A total of 387 obesity surgery procedures were performed; 372 patients (96%) were discharged without complication. Fifteen (3.9%) were transferred to the main campus, eight were admitted to ICU and two required re‐operation. Twelve (3.1%) were readmitted within 30 days of discharge, five required re‐operation. Transfer, 30‐day readmission and 30‐day emergency department presentation rates were similar in comparison to LC. RTT during index admission (0.5% vs. 3.0%; p = 0.006) and during 30‐day post‐operative period (1.8% vs. 4.4%; p = 0.025) was lower in the obesity surgery group. Conclusion Carefully selected screening criteria allow obesity surgery to be performed at a well‐supported non‐HDU/ICU facility with few complications and acceptable rates of unplanned patient transfer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy of patient selection criteria for obesity surgery in a non‐high‐dependency unit/intensive care unit facility

Newbold

Craven

Aly

2021

ANZ Journal of Surgery

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“…In addition, due to the disruption in surgical care delivery due to the COVID-19 pandemic, this approach might reduce in-hospital exposure and save precious resources [10]. Several single institutional reports have shown the feasibility and safety of same-day discharge SG with low postoperative morbidity and nearzero mortality [11][12][13][14][15][16]. However, a shorter length of stay (LOS) may also result in a higher rate of postoperative complications and readmissions when compared with the classic inpatient approach [17].…”

Section: Key Pointsmentioning

confidence: 99%

Risk Factors for Readmission After Same-Day Discharge Sleeve Gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis

et al. 2022

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Background Same-day discharge after sleeve gastrectomy (SG) is gaining popularity. We aimed to determine risk factors associated with readmission in patients who underwent same-day discharge SG. Methods We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for the period 2015-2018. Patients who underwent SG and were discharged the same day of the operation were included in the analysis. Multivariable logistic regression analysis was performed to determine risk factors for readmission. Results A total of 466,270 SG were performed during the study period; 14,624 (3.1%) patients were discharged the same day and were included in the analysis. Mean age was 43.4 (14.7-80) years and 11,718 (80.1%) were female. Mean preoperative BMI was 43.7 ± 7.4 kg/m 2 . Mean operative time was 58.3 ± 32.4 min. Thirty-day reoperation, reintervention, and mortality rates were 0.7%, 0.7%, and 0.1%, respectively. Readmission rates were similar in same-day discharge and inpatient SG (2.9% vs. 3%, p = 0.5). Female sex (OR 1.52, 95% CI 1.15-2.00), preoperative gastroesophageal reflux disease (OR 1.33, 95% CI 1.08-1.64), renal insufficiency (OR 3.06, 95% CI 1.01-9.32), and intraoperative drain placement (OR 1.78, 95% CI 1.37-2.31) were independent risk factors for readmission following same-day discharge SG. Conclusions Same-day discharge SG appears to be safe and is associated with low readmission rates. However, the identification of preoperative and intraoperative variables associated with higher risk of readmission might help defining safer and more effective same-day discharge protocols.

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“…Same-day discharge (SDD) in patients after a laparoscopic sleeve gastrectomy (SG) has been described by Surve et al 2018, who performed a large retrospective study of 3162 patients undergoing primary SG in SDD and who found increased morbidity and mortality rates compared to patients who stay for at least one night [4]. However, several small prospective studies assessed SDD after SG using a strict selection of patients did not show increased morbidity and mortality [5][6][7][8][9][10][11]. The only available data about SDD after RYGB is from three retrospective studies with conflicting results regarding feasibility and safety [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass Using Remote Monitoring

et al. 2021

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Background Shortening of hospital stay to 1 night has not affected the short-term safety of patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). Whether the RYGB is feasible in an ambulatory setting (same-day discharge) without overnight hospital stay remains to be answered. We aimed to evaluate the feasibility of same-day discharge after laparoscopic Roux-en-Y gastric bypass (RYGB) using additional live video consultation and remote monitoring. Same-day discharge (SDD) was defined as surgery without postoperative overnight hospital stay. Methods This was a single-center prospective feasibility study in a selected group of patients undergoing a RYGB. Fifty patients undergoing a primary RYGB were selected and potentially treated following the SDD protocol. After SDD discharge patients were remotely monitored after surgery for 48 h using a medical device measuring vital signs three times a day. Video consultations were performed by a doctor twice a day for 2 postoperative days. Primary outcome was the success rate (%) of SDD. Secondary outcomes were emergency room presentations, readmissions, early complications (<30 days), and patient satisfaction. Results A total of 50 patients were selected for the SDD treatment protocol between June 2020 and November 2020. An SDD success rate of 88 % (44/50 patients) was achieved. Five patients (10%) presented at the emergency room, 2 of whom (4%) were readmitted because of a complication within 30 days after surgery. Overall, patients who followed the SDD protocol reported high satisfaction scores. Conclusion A RYGB with SDD can be considered feasible using remote monitoring for a selected group of patients. Graphical abstract

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Laparoscopic sleeve gastrectomy as a viable option for an ambulatory surgical procedure: our 52-month experience

Cited by 47 publications

References 10 publications

Efficacy of patient selection criteria for obesity surgery in a non‐high‐dependency unit/intensive care unit facility

Efficacy of patient selection criteria for obesity surgery in a non‐high‐dependency unit/intensive care unit facility

Risk Factors for Readmission After Same-Day Discharge Sleeve Gastrectomy: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis

Feasibility of Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass Using Remote Monitoring

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