Comparison of safety and utilization outcomes in inpatient versus outpatient laparoscopic sleeve gastrectomy: a retrospective, cohort study

• Published in: Surgery for obesity and related diseases Vol. 16; no. 11; pp. 1661 - 1671
• Main Authors: Fortin, Stephen P., Kalsekar, Iftekhar, Johnston, Stephen, Akincigil, Ayse
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020
• Subjects: Adolescent; Adult; Bariatric Surgery; Cohort Studies; Day-case; Gastrectomy; Humans; Inpatients; Laparoscopic sleeve gastrectomy; Laparoscopy; Obesity, Morbid - surgery; Outpatient; Outpatients; Postoperative Complications - epidemiology; Retrospective Studies; Safety outcomes; Treatment Outcome; United States - epidemiology; Utilization outcomes; United States; Outpatient; Utilization outcomes; Laparoscopic sleeve gastrectomy; Day-case; Safety outcomes; Bariatric surgery
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2020.07.012

Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery performed in the United States and may be performed on an outpatient basis. Limited literature exists comparing outcomes of outpatient and inpatient LSG, and study results are conflicting.
To compare safety and utilization outcomes of outpatient versus inpatient LSG.
Retrospective, multihospital database study (Optum Pan-Therapeutics Database).
Patients 18 years of age and older who underwent LSG between October 1, 2015, and December 31, 2018, were identified from the Optum Pan-Therapeutics Database and classified as having undergone outpatient or inpatient surgery. Nearest neighbor propensity score matching and generalized estimating equations accounting for procedural physician-level clustering were used to compare the following outcomes between outpatient and inpatient LSG: all-cause 30-day patient morbidity, hospital readmission, readmission length of stay, bariatric reoperation. and mortality.
We identified 22,945 patients (outpatient: 1542; inpatient: 21,403) meeting the study inclusion criteria. After propensity score matching, the inpatient and outpatient groups contained 1542 and 13,903 patients, respectively. Bariatric reoperation (n = 13) and mortality (n = 5) were rare events occurring in <.1% of all cases. Compared with the inpatient group, the outpatient group had a statistically significant lower readmission length of stay (4.63 versus 3.23 days; P = .0057). Otherwise, there was no significant association between procedure setting and 30-day overall morbidity (4.8% versus 5.3%; P = .5775) or hospital readmission (2.6% versus 2.1%; P = .1841).
Safety and utilization outcomes were similar between outpatient and inpatient LSG, and outpatient LSG was associated with shorter hospital readmission length of stay.