Safety and feasibility of bariatric surgery without inpatient hospital admission-prospective study

ABSTRACT

Background: Delays from the COVID-19 pandemic led to increased surgical wait times. With ongoing bed pressures, we must safely maximize surgical volumes. We prospectively evaluated the feasibility and safety of bariatric surgery without inpatient hospital admission. Methods: We identified patients whose elective bariatric surgery we felt could be safely scheduled without inpatient admission to a surgical ward. Patients recovered in an 'overnight stay' perioperative area. Selection criteria excluded patients with revisional surgery, BMI≥55, insulin-dependent diabetes, or therapeutic anticoagulation. Data were collected on consecutive patients scheduled without admission between April and June 2021. Seven-day emergency department (ED) visits and readmissions were used to establish the safety of this intervention. Results: Of 47 patients scheduled for surgery without admission, 42 (89.4%) underwent Roux-en- Y gastric bypasses and 5 (10.6%) sleeve gastrectomies. Patients stayed between 16 and 23 hours, with a mean and median of just over 20 hours. Only 2 (4.3%) patients required admission to the surgical ward, but both were discharged on postoperative day 1 (POD1). Only 2(4.3%) patients had ED visits within 7 days postoperatively, and neither required admission. There were no complications, reoperations, or deaths. A control group of bariatric surgery patients with planned hospital admission per usual care is being analyzed for comparison. Conclusions: We demonstrated that bariatric surgery can be performed without inpatient hospital admission in select patients. We anticipate our controls will further confirm the safety of this endeavor. Optimizing resource utilization is crucial now, as hospitals recover from the pandemic and prepare for potential future waves.