Same Day Discharge after Metabolic and Bariatric Surgery in Adults 65 Years and Older: An Analysis of the 2015 to 2022 MBSAQIP

There is increasing interest in same day discharge (SDD) after metabolic and bariatric surgery (MBS). Among older adults, the safety of SDD is unclear and, as a result, this age group is often excluded from SDD protocols. We aimed to characterize the safety profile of SDD in adults ≥ 65 years.

The 2015–2022 MBSAQIP was queried for patients ≥ 65 years undergoing primary sleeve gastrectomy or RYGB. Patients were stratified based on postoperative day (POD) of discharge: SDD, POD1, POD2, POD3, and ≥ POD4. Logistic regression was used to examine associations between SDD and 30-day Clavien-Dindo complications and readmissions.

We identified 63,486 patients ≥ 65 years; the median (IQR) age was 68 (4) years. Overall, 2.12% of patients underwent SDD while the majority (52.8%) were discharged on POD1. From 2015 to 2022, the proportion with SDD increased from 1.15% to 4.33%. Compared to those discharged on later days, patients undergoing SDD had proportionally fewer obesity-associated diseases, including insulin-dependent diabetes (SDD 14.2%, POD1 15.5%, POD2 20.4%, POD3 23.2%, POD4 + 26.1%) and COPD (SDD 3.2%, POD1 4.7%, POD2 5.7%, POD3 7.2%, POD4 + 9.6%) (all p < 0.001). Compared to POD1 discharge, SDD was not significantly associated with any class of Clavien-Dindo complications or 30-day readmissions (all p > 0.05).

Though use of SDD after MBS in adults ≥ 65 years has increased from 2015 to 2022, it remains an uncommon practice. Those undergoing SDD have fewer obesity-associated diseases and, in this select cohort of older adults, SDD is not associated with worse postoperative morbidity and mortality. Careful patient selection is critical for safe SDD in adults ≥ 65 years.