Laparoscopic sleeve gastrectomy as day-case surgery versus conventional hospitalization: results of the DAYSLEEVE randomized clinical trial |
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| Affiliation: | 1. Department of Obesity and MIS Surgery, New You Medical Center, Riyadh, Saudi Arabia;2. Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia;1. Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota;2. Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania;3. Department of Psychiatry, New York University Grossman School of Medicine, New York, New York;4. Advanced Surgical Partners of Virginia, Richmond, Virginia;5. Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;6. Massachusetts General Hospital Weight Center, Boston, Massachusetts;7. New York University Langone Medical Center, Division of Bariatric Surgery and Weight Management, New York, New York;1. Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University School of Medicine, Stanford, California;2. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California;3. Stanford University School of Medicine, Stanford, California;4. Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California;1. American Board of Obesity, Denver, Colorado;2. Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts;3. Department of Surgery, Stanford University School of Medicine, Stanford, California;4. Department of Surgery, Lewis Katz School of Medicine at Temple University, St. Luke’s University and Health Network, Philadelphia, Pennsylvania;5. Department of Bariatric Surgery, Adventist Medical Center Bolingbrook, Bolingbrook, Illinois;6. Department of Surgery, Morsani College of Medicine, USF Health, Tampa, Florida;7. Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts;8. Unitypoint Clinic Weight Loss Specialists, West Des Moines, Iowa;9. Department of Surgery, University of Iowa, Iowa City, Iowa;10. Vanderbilt Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee;11. Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee;12. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee;13. Division of Endocrinology, Diabetes, and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medicine, New York, New York;14. Weill Center of Metabolic Health, Weill Cornell Medicine, New York, New York;15. Department of Surgery, Houston Methodist Academic Institute, Texas A&M University College of Medicine, Houston, Texas;p. Department of Medicine, Harvard Medical School, Boston, Massachusetts;q. Divisions of Surgery and Endocrinology, Massachusetts General Hospital Weight Center, Boston, Massachusetts;1. Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy;2. Department of General Surgery, University Hospital of North Tees, Stockton-on-Tees, UK;3. Department of General Surgery, Royal Free London NHS Foundation Trust, London, UK;4. Department of General Surgery, Inverclyde Royal Hospital, Greenock, Scotland, UK;5. Department of General Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK;6. Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK |
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| Abstract: | ![]()
BackgroundLaparoscopic sleeve gastrectomy (LSG) is an effective bariatric intervention with short operative time and low morbidity and mortality. However, ambulatory sleeve gastrectomy is underutilized.ObjectiveThis 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.SettingHospital and ambulatory surgery center.MethodsPatients 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.ResultsOf 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%.ConclusionLSG is feasible as a day-case procedure with comparable outcomes to conventional hospitalization. |
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| Keywords: | Ambulatory surgery Sleeve gastrectomy Clinical trial Day-case surgery |
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