Safety and efficacy of outpatient sleeve gastrectomy: 2534 cases performed in a single free-standing ambulatory surgical center

• Published in: Surgery for obesity and related diseases Vol. 15; no. 6; pp. 832 - 836
• Main Authors: Billing, Peter, Billing, Josiah, Harris, Eric, Kaufman, Jedediah, Landerholm, Robert, Stewart, Kurt
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2019.03.003

Sleeve gastrectomy (SG) is currently the most widely performed operation for treatment of morbid obesity. SG leads to significant weight loss and reduction in weight related comorbidities. Procedures performed in ambulatory surgical centers (ASC) can provide several advantages over hospital-based surgery. We present results of 2,534 consecutive patients who underwent SG in an ASC.
Assess the safety and efficacy of outpatient SG in a freestanding ASC.
Free-standing ASC, Eviva Bariatrics, Seattle WA.
Data was collected retrospectively for all patients undergoing SG from January 2008 – January 2018, n = 2,534. Revisional procedures were not excluded from this study. Patients were excluded from the ASC if they weighed >450 pounds, if anticipated surgery time was > 2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours.
Mean age was 45.9 years. Mean preoperative body mass index (BMI) was 41.9. Mean operative time was 70 minutes. 30-day complications included 3 mortalities (0.12%), 60 (2.53%) re-admissions, 35 (1.42%), re-operations, and 31 (1.22%) direct transfers from the ASC to a nearby hospital. There were 25 staple line leaks (0.99%). There were no open conversions. At 6 months average excess body weight loss (EWL) was 56.3% and total weight loss (TWL) was 20.9% (n = 1,758/2,303). At 1 year, EWL was 70.1% and TWL was 26.4% (n = 1,199/2,125).
With experienced surgeons, appropriate protocols, and a consistent operative team, SG can be performed safely in a free-standing ASC.
•2,534 sleeve gastrectomy cases were reviewed from a single outpatient center•Complications rates were comparable to published inpatient rates•Re-admissions, re-operations, and transfer rates were 2.53%, 1.42%, and 1.22%•There were 3 mortalities (0.12%) with none occurring in the last 1,958 cases•Patient selection and protocol based medicine is critical•The data supports that sleeve gastrectomy can be safely done outpatient