Background

Vertical Sleeve Gastrectomy (VSG) dominates US bariatric surgeons, with 61% performed in 2020.1 The main concern with same-day discharge VSG patients is persistent nausea/vomiting leading to nausea, dehydration and delayed detection of postoperative hemorrhage.3 With the introduction of specific anesthesia protocols and perioperative care, the readmission rate can be reduced to 0.04 - 0.5% 5-7.

Methods

A single-center institution studied all patients undergoing sleeve gastrectomy with robotic assistance between October 1, 2021 and July 1, 2023. 167 patients prospectively studied. Patients were categorized into same-day discharge or overnight admission. Logistic regression models were used to identify medications and patient characteristics applicable to each group defined.

Results

Findings revealed 80.2% (N=134) were discharged same day, while those staying overnight had higher BMI's, longer operative times, and severe OSA and higher ASA scores. Twelve medications were associated with length of stay. Notably, the odds of being admitted overnight among patients who received glycopyrrolate with neostigmine during surgery was 2.67 (OR: 2.67, 95% CI: 1.05-7.33) when adjusting for other medications and demographic characteristics.Furthermore, the safety of same-day discharge was evaluated, showing a mere 1.8% readmission rate within seven days and a similar percentage with an ED encounter within 72 hours post-discharge.

Conclusions

Patients admitted overnight were generally less healthy than same day discharge. While two medications showed significant association with length of stay, causation wasn't established. Notably, same day discharged posed no immediate post-operative adverse events.