Laparoscopic sleeve gastrectomy as day-case surgery versus conventional hospitalization: results of the DAYSLEEVE randomized clinical trial

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric intervention with short operative time and low morbidity and mortality. However, ambulatory sleeve gastrectomy is underutilized.

Objective: This clinical trial compares feasibility, perioperative outcomes, and weight loss of patients undergoing ambulatory LSG with same-day discharge versus conventional hospitalization with next-day discharge.

Setting: Hospital and ambulatory surgery center.

Methods: Patients who satisfied low-acuity criteria were randomized to undergo day-case LSG in the ambulatory surgery center with same-day discharge (DC LSG) or LSG with conventional hospitalization and next-day discharge (CH LSG) between December 2018 and December 2020. The primary outcomes were 30-day adverse events, hospitalizations, reoperations, and readmissions, and the secondary outcome was weight loss during the first year.

Results: Of 2541 screened patients, 1544 patients were randomized in the study. Mean age and body mass index were 31.7 ± 9.1 years versus 31.8 ± 9.2 years and 39.6 ± 5.8 kg/m² versus 40.0 ± 5.7 kg/m² in the DC LSG group (n = 777) and in the CH LSG group (n = 777), respectively. Eighteen patients (2.3%) in the DC LSG were transferred to the hospital for overnight stay. Additionally, 13 patients (1.7%) requested additional stay without a medical indication for a total overnight stay rate of 4%. One DC LSG patient (.1%) was readmitted, and 2 CH LSG patients (.3%) stayed for an extra day. Seventeen percent of DC LSG patients had unscheduled consultations during the first postoperative week compared with 6% of CH LSG patients (P < .001). Those 2 groups were similar in baseline characteristics. There were no reoperations or mortality in either group, and weight loss results were similar; At 1-year follow-up, DC LSG percent excess weight loss was 87% ± 17% compared with 85% ± 17% in the CH LSG group. The follow-up rate was 100%.

Conclusion: LSG is feasible as a day-case procedure with comparable outcomes to conventional hospitalization.

Keywords: Ambulatory surgery; Clinical trial; Day-case surgery; Sleeve gastrectomy.