Same-Day Discharge Versus Extended-Stay Robotic Metabolic Bariatric Surgery Including Duodenal Switch and Conversions, Prospective 10-year Safety Study

Abstract Objective: Examine the safety of same-day discharge (SDD) after robot-assisted metabolic bariatric surgery (RMBS) comprising duodenal switch (DS), conversion surgery (CS), single anastomosis duodenal ileal bypass (SADI), vertical sleeve gastrectomy (VSG), and other RMBS surgeries. Setting : Hospital-based ambulatory surgery facility, single surgeon, private practice Methods: 926 consecutive patients underwent RMBS between 2013 and 2023. Twenty-nine patients were excluded because of a serious event during the index admission, leaving 897 patients for analysis. 568 patients were discharged ~2-6 hours post-surgery (SDD cohort), and 329 had extended stays (ES cohort; ≥24 hours). 30-day all-occurrence morbidity (including serious events, reoperations, readmissions, interventions, and postoperative occurrences) used to compare the cohorts. Results: The incidence of patients with ≥1 all-occurrence morbidity event was similar across SDD (5.5%) and ES (6.1%) cohorts. Surgery type predicted for the incidence of all-occurrence morbidity (p=0.0073); CS and Other surgeries had the greatest morbidity risk (i.e., were significantly worse than VSG reference). Smokers (p=0.0198), diabetes (p=0.0254), and number of hypertension medications (p=0.0004) were also predictors of all-occurrence morbidity. SDD of patients after RMBS had no significant effect (p=0.5454) on the incidence of all-occurrence morbidity. The model adjusted for all variables that confounded SDD. In addition, safety of discharging patients early, as measured by all-occurrence morbidity, was not moderated by type of RMBS performed (p=0.4224). Conclusions: Thirty-day all-occurrence morbidity in the SDD cohort was not significantly different from the ES cohort, suggesting that patients undergoing RMBS can be safely discharged on the same day by centers experienced in these complex surgeries.