Comparison of laparoscopic sleeve gastrectomy as a day surgery and conventional inpatient surgery: Results of a randomized clinical trial
Background: Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery with a short operation time and low complication and mortality rates. However, the application of outpatient sleeve gastrectomy is insufficient.
Objective: This clinical trial aims to compare the feasibility, perioperative outcomes, and weight loss effects of sleeve gastrectomy performed as a day surgery (discharge on the same day) with those of conventional inpatient surgery (discharge on the second day).
Setting: Hospital and outpatient surgery center.
Methods: From December 2018 to December 2020, patients meeting the low-risk criteria were randomly assigned to receive same-day discharge after single-day laparoscopic sleeve gastrectomy (DC LSG) in a day surgery center or to receive laparoscopic sleeve gastrectomy (CH LSG) with discharge the next day after hospitalization. The primary outcome measures were adverse events, hospitalization, reoperation, and readmission within 30 days, and the secondary outcome measure was weight loss in the first year after surgery.
Among the 2,541 patients who underwent screening, 1,544 were randomly included in the study. In the DC LSG group (n = 777) and the CH LSG group (n = 777), the average age was 31.7 ± 9.1 years and 31.8 ± 9.2 years, respectively, and the average BMI was 39.6 ± 5.8 kg/m² and 40.0 ± 5.7 kg/m², respectively. In the DC LSG group, 18 patients (2.3%) were transferred to the hospital for overnight observation. Additionally, 13 patients (1.7%) requested additional overnight stays without medical indications, resulting in an overall overnight rate of 4%. One patient (0.1%) in the DC LSG group was readmitted, while two patients (0.3%) in the CH LSG group stayed an extra day. During the first postoperative week, 17% of patients in the DC LSG group had unplanned visits, compared with 6% in the CH LSG group (P < 0.001). The baseline characteristics of the two groups were similar. There were no reoperations or deaths in either group, and the weight loss effects were also similar; at the 1-year follow-up, the percentage of excess weight loss in the DC LSG group was 87% ± 17%, while in the CH LSG group it was 85% ± 17%. The follow-up rate was 100%.
Conclusion: Laparoscopic cholecystectomy (LSG) as a day surgery is feasible and its effect is comparable to that of conventional inpatient treatment.
Key words: Outpatient surgery; Clinical trial; Day surgery; Sleeve gastrectomy.
Comment
Comment Object: Laparoscopic Sleeve Gastrectomy as Day Surgery vs. Conventional Inpatient Treatment: Results of the DAYSLEEVE Randomized Clinical Trial.
