Background

The COVID-19 pandemic impacted healthcare delivery worldwide. Resource limitations prompted a multi-institutional quality initiative to enhance same-day discharge workflow after sleeve gastrectomy to reduce the inpatient hospital burden. This study aims to determine the safety and efficacy of this initiative, as well as potential modifiable and non-modifiable risk factors for inpatient admission.

Methods

A retrospective analysis of sleeve gastrectomy patients was conducted from January 2019 to August 2021. Inclusion criteria was discharge on postoperative day zero, one, or two. Patients were divided into same-day discharge (SD) and inpatient cohorts. Demographic, operative, and postoperative variables were compared, as well as monthly trends in same-day and inpatient care. Potential risk factors for inpatient admission were assessed.

Results

Analysis included 2,209 sleeve gastrectomy surgeries (462 SD, 1,747 inpatient). Significant differences between cohorts were age, hypertension, obstructive sleep apnea, pre-/post-COVID, facility, and combination procedure (e.g. paraesophageal hernia). Monthly frequency of same-day discharge rose from 13% in June 2020 to 75% in August 2021. There was no difference in rates of inpatient readmission, reoperation, mortality, or 6-month excess weight loss. SD discharge patients had higher rates of 7-day emergency department readmission (9% vs 5%, p=0.004). Potential risk factors for inpatient admission include: age, BMI, diabetes mellitus, hypertension, obstructive sleep apnea, surgery date, facility, and combination case.

Conclusions

Same-day discharge after sleeve gastrectomy is safe and efficacious. Administrative support for extended PACU (postanesthesia care unit) recovery was critical to successful protocol implementation for same-day discharge within this large multi-institutional healthcare system demonstrating potential applicability nationwide.