NATIONAL HARBOR, Md.—Careful patient selection is critical for safe implementation of same-day discharge for those undergoing metabolic surgeries.

That’s the conclusion of new research from the Center for Obesity Research, Innovation, and Education at Hartford HealthCare’s Digestive Health Institute, in Conn. Presented at the 2025 annual meeting of the American Society for Metabolic and Bariatric Surgery, the results of a large retrospective review found that 50% of patients who underwent same-day discharge following sleeve gastrectomy could be considered high risk, 32% had multiple risk factors, and more than 650 patients were American Society of Anesthesiology (ASA) class IV or V.

“The observed outcomes suggest that same-day discharge practices for sleeve gastrectomy may reflect suboptimal patient selection,” said Sara Saeidi, MD, a research fellow at Hartford Hospital, in Connecticut. “Future work should focus on developing a weighted risk scoring system and risk models to balance patient safety with the advantages of same-day discharge.”

Same-day discharge following metabolic procedures started as part of enhanced recovery after surgery protocols that emphasize early mobilization, pain control and efficient recovery, she said. “However, the real acceleration came during the COVID-19 pandemic, when hospitals were under pressure to preserve bed capacity,” she noted. Same-day discharge has been increasingly adopted by high-volume surgery centers with established protocols, but its application is “still inconsistent,” often due to concerns about patient safety, Dr. Saeidi said.

“The literature strongly emphasizes patient selection for same-day discharge,” she said. “However, it is unclear how patients at risk are selected for same-day discharge, and no study has evaluated the association between preoperative risk profiles and postoperative outcomes.”

During the study, investigators compared 30-day postoperative outcomes among patients undergoing same-day or next-day discharge for sleeve gastrectomy, stratified by high- and low-risk groups. They pulled patient information from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2020 to 2023. They included all patients undergoing primary sleeve gastrectomy who had a body mass index over 30 kg/m² and excluded those undergoing revision or conversion procedures, open approaches and those who died in the hospital.

They defined low-risk patients as those younger than 65 years of age with a BMI of less than 50 kg/m² and no history of foregut surgery, diabetes, sleep apnea, cardiovascular disease, kidney disease, immunosuppression or thromboembolic events. High-risk patients were defined as having at least one of the aforementioned conditions, or being 65 years of age or older, having a BMI of 50 kg/m² or higher, and an ASA score of IV or higher.

The main outcomes were comprehensive complication index (CCI), serious adverse events and mortality rate. Researchers used multiple logistic regression models to assess outcomes.

Overall, 322,105 patients underwent sleeve gastrectomy. Of those, 40,387 (12.5%) were same-day discharge (50.4% low risk and 49.6% high risk). The remainder, 281,718 patients (87.5%), were next-day discharge (41.2% low risk and 58.8% high risk). The same-day discharge population generally was younger, had a lower BMI and lower prevalence of comorbidities. However, 667 patients discharged the same day (1.7%) were ASA class IV or V.

High-risk patients selected for same-day discharge had higher mean CCI scores (1.45 vs. 1.18; P<0.01), more serious adverse events (1.1% vs. 0.7%; P<0.01) and higher mortality (15 vs. four cases; P=0.11) than low-risk patients, respectively. High-risk patients discharged the same day had a 26% higher risk for experiencing serious adverse events compared with being discharged the next day (P<0.001). By contrast, low-risk patients had similar outcomes regardless of day of discharge. Two-thirds (66.9%) of high-risk patients had at least one major risk factor, about 26% had two and about 7% had three or more. The likelihood of serious adverse events increased along with the number of risk factors, Dr. Saeidi said.

Study limitations include that MBSAQIP data lack frailty status, patient preferences and socioeconomic factors that could influence discharge decisions; outpatient surgery centers not accredited by MBSAQIP were not captured in the data set; and investigators did not evaluate the independent or synergistic effects of risk factors on outcomes, she said.

The work “offers valuable insights into optimizing patient safety and outcomes as our field evolves,” said Adrian Dan, MD, FACS, FASMBS, the medical director of the Weight Management Institute at Summa Health System, in Akron, Ohio, following the presentation. “Same-day discharge of high-risk patients is associated with increased serious complications … and without stratifications, there are missed opportunities to intervene in the golden window postoperatively that may avoid morbidity and mortality.”

Drs. Dan and Saeidi reported no relevant financial disclosures.