Laparoscopic Sleeve Gastrectomy As Day-Case Surgery Versus Conventional Hospitalization: Results of the DAYSLEEVE Randomized Clinical Trial

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/m(2) versus 40.0 +/- 5.7 kg/m(2) 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. Addition-ally, 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% & PLUSMN; 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. (C) 2022 Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery.