Same day discharge metabolic and bariatric surgery: Experience of a bariatric tertiary center

Abstract:

Since the event of minimally invasive surgery, bariatric surgery has taken such a lead that, in Canada, lack of hospital beds, budgets and manpower has made us look at other issues in order to be able to operate our patients in a reasonable time. This study examines the feasibility of same-day discharge (SDD) in metabolic and bariatric surgery within a bariatric tertiary center, addressing challenges related to hospital resources. Early experiences starting in 2009 with sleeve gastrectomies showed that 42% of patients were released within 12 hours. A series of 69 consecutive patients presented at the third International Summit on Sleeve Gastrectomy in New-York in 2010, revealed a retention rate of 2.9% and a readmission rate of 1.4%, with minor and major complication rates of 4.3% vs 5.1% and 4.3% vs 8.5% respectively.

In a larger series of 980 patients undergoing laparoscopic sleeve gastrectomy (LSG), 328 (33.5%) were operated on an SDD basis, with 322 patients (98.2%) discharged on the day of surgery. This group showed a retention rate of 1.8% and a readmission rate of 8.5%, primarily for minor issue. Our results were published in 2016 and were comparable to other published series. Applying SDD protocols to SADI procedures and gastric bypass in 208 patients resulted in a retention rate of 4.8% and a readmission rate of 5.8%, with minor and major complications rates of 11.9% and 3.9% respectively. The findings suggest that SDD is a viable option for various bariatric procedures, with acceptable retention and readmission rates.

Biography:

Dr. Ronald Denis is a renowned Canadian general surgeon and trauma specialist, with nearly 40 years of clinical and leadership experience. A graduate of the Université de Montréal, he completed his trauma surgery specialization in Detroit in 1983 and played a pivotal role in establishing Quebec’s first trauma unit at the Hôpital du Sacré-Cœur de Montréal. He has held numerous leadership positions, including Chief of Surgery at both Hôpital du Sacré-Cœur and CIUSSS du Nord-de-l'Île-de-Montréal, and currently serves as Director of the Trauma Program and Head of Robotic Surgery. He was the first in Canada to perform robotic surgery using the Da Vinci system. Dr. Denis has also made significant contributions to motorsport safety, leading medical teams at the Canadian Grand Prix and NASCAR events, and was inducted into the Canadian Motorsport Hall of Fame in 2019. He is a member of the FIA Medical Commission. In academia, he is a Clinical Associate Professor at Université de Montréal and has mentored over 150 surgeons. He has presented at over 100 conferences and co-authored nearly 70 scientific publications.