Dear Editor, Laparoscopic sleeve gastrectomy (LSG) is a standard bariatric procedure performed in individuals with severe obesity and associated metabolic derangements. Recently, reducing length of hospital stay while maintaining safety has been increasingly promoted under enhanced recovery after surgery (ERAS) protocols1. The systematic review and meta-analysis by Mobarak et al provide a valuable systematic assessment of same-day discharge (SDD) in bariatric patients2. While multiple meta-analyses (Mobarak et al2, Vanetta et al) have concluded that SDD appears safe in the short term, all are limited by heterogeneous retrospective data, highlighting the need to critically examine the evidence before widespread implementation 2, Supplemental Digital Content Annex 1, available at: https://links.lww.com/JS9/H264. More research is needed to resolve the remaining concerns for the improved practicability and validity of these findings. First, the meta-analysis by Mobarak et al demonstrated feasibility of SDD after LSG, though notable limitations persist3. Studies predominantly included low-risk cohorts (ASA I–II, BMI <45 kg/m2), leaving high-risk populations underrepresented Supplemental Digital Content Annex 2, available at: https://links.lww.com/JS9/H265, Supplemental Digital Content Annex3, available at: https://links.lww.com/JS9/H266, Supplemental Digital Content Annex4, available at: https://links.lww.com/JS9/H267, Supplemental Digital Content Annex 5, available at: https://links.lww.com/JS9/H268. Critical perioperative factors, such as anesthesia recovery, postoperative nausea and vomiting (PONV) management, intraoperative drain placement, and post-discharge monitoring, were inadequately evaluated for readmission risk (Supplemental Digital Content Annex3, available at: https://links.lww.com/JS9/H266, Supplemental Digital Content Annex 6, available at: https://links.lww.com/JS9/H269). Database analyses indicate that female sex, preexisting GERD, renal dysfunction, and drain placement are independent predictors of SDD readmission (Supplemental Digital Content Annex3, available at: https://links.lww.com/JS9/H266). A risk-stratified framework incorporating these factors is essential to optimize patient selection (Supplemental Digital Content Annex7, available at: https://links.lww.com/JS9/H270). Second, significant variability in SDD definitions and implementation designs across studies contributed to heterogeneity and limited comparability. The discharge criteria in these studies mainly focused on the absence of postoperative complications such as nausea, vomiting, or bleeding, rather than comprehensive physiological or functional recovery indicators. The variation in discharge criteria (e.g., complication-free status vs. functional recovery) may explain differences in readmission rates across studies4. Moreover, inter-center variations in baseline characteristics, including ASA classification, BMI, and comorbidity profiles, further complicate comparisons (Table 1). Based on the reviewed literature, a standardized discharge protocol should include: (1) hemodynamic stability, (2) adequate pain control (e.g., VAS <4), (3) tolerance of oral intake, (4) absence of active bleeding or severe nausea, and (5) ability to ambulate safely. We recommend the use of standardized patient selection and discharge criteria, along with consistent perioperative monitoring protocols, to enhance the reproducibility of future research. Table 1 - Comparative analysis of SDD: definitions similar rates of leakage and bleeding compared to inpatient group; slightly higher readmission rate. 30 days Registry-based; lacks detailed functional discharge criteria. Kleipool S.C. et al Supplemental Digital Content Annex5, available at: http://links.lww.com/JS9/H268 Protocol-based SDD after sleeve gastrectomy (feasibility study). SDD success 88% (45/51); non-discharged patients mainly due to PONV or mild bleeding; one 48-h readmission Short-term (48 h +) Focuses on feasibility; discharge based on clinical stability. Landreneau JP et al Supplemental Digital Content Annex9, available at: http://links.lww.com/JS9/H272 Outpatient SDD program vs. inpatient stay in an academic setting. No difference in perioperative complications; significant cost reduction (~6.8%). Index admission + 30 days Includes cost analysis; discharge likely includes mobilization criteria. Vanetta C. et al Supplemental Digital Content Annex10, available at: http://links.lww.com/JS9/H273 SDD as discharge on surgery day without overnight stay. (LSG). SDD after SG; readmission 0.6–20.8% (this study: 4%); overall morbidity, reoperation, and mortality indicate SDD SG appears feasible and safe. 30 days Meta-analysis; highlights wide readmission range due to differing definitions. Third, the reporting of important clinical outcomes remains poor. Prospective data on postoperative pain, quality of life, health care costs (including cost-effectiveness), readmission rates, reoperation rates, and mortality are scarce; thus, the VAS pain scores and SF-36 quality-of-life questionnaires were reported less frequently in patients with SDD than in traditional inpatients who underwent laparoscopic cholecystectomy (LC)5. Further studies are needed to investigate the cost savings of SDD for bariatric surgery. Fourth, although current evidence confirms short-term safety, the follow-up is brief (mostly 30 days), limiting assessment of long-term sequelae and postoperative weight maintenance. Future research with planned extended follow-up (6–12 months) – systematically evaluating weight, morbidity, and quality of life – is needed to clarify the long-term effects of early discharge on health and surgical outcomes. Implementing the SDD protocol involves assessing the hospital resources, training staff, and ensuring adequate patient support. Adaptations to diverse settings are crucial and would benefit from customized remote patient monitoring protocols. For example, remote monitoring could include daily telehealth check-ins, automated vital sign tracking via wearable devices, or structured nurse-led telephone follow-up to identify complications early (Supplemental Digital Content Annex6, available at: https://links.lww.com/JS9/H269,Supplemental Digital Content Annex11, available at: https://links.lww.com/JS9/H274). In conclusion, while SDD after LSG appears feasible, urgent action is needed to standardize SDD protocols globally and validate their safety across diverse healthcare settings. Emphasizing study quality, managing heterogeneity through standardized definitions and discharge criteria, prioritizing patient-centered outcomes, and implementing supportive structures like remote monitoring are essential next steps. Transparency Statement: This research is reported in line with the TITAN guideline for transparency in the use of artificial intelligence6. The author declares that no artificial intelligence tools were used in the creation of this manuscript.
Liu et al. (Mon,) studied this question.