TOPLINE

A systematic review of 41 studies on same‑day discharge after metabolic bariatric surgery (MBS) found that 94%-100% of studies used unique definitions for patient selection and discharge readiness — heterogeneity severe enough to preclude valid meta-analysis. The authors said this reflected a lack of methodological standardization, not poor individual study quality.

METHODOLOGY

• Same-day discharge after MBS has become more common under enhanced recovery after surgery protocols but reported success rates vary widely — from about 15% to 100%. No prior systematic review examined whether studies used comparable patient selection and discharge definitions, a prerequisite for valid pooled evidence.
• Researchers conducted a systematic review by comprehensively searching major databases from inception through January 2025 for studies reporting same-day discharge after any primary MBS in adults.
• They included 41 studies from 15 countries covering 1,953,247 patients: four randomized trials (n = 2039), 23 cohort studies (n = 63,482), 11 registry studies (n = 1,887,706), one case-control study, and two cross-sectional studies.
• Inclusion, exclusion, and discharge criteria from each study were compared word-for-word to flag identical vs unique definitions. A separate thematic analysis checked whether studies at least shared underlying concepts even when their specific thresholds didn’t match.
• The primary outcome was the proportion of studies using unique (nonshared) criteria definitions; an a priori threshold of ≥ 80% unique definitions indicated that a meta-analysis would be inappropriate.

TAKEAWAY

• Among studies that reported criteria, 95% (38 out of 40 studies) used unique inclusion definitions, 94% (34 out of 36 studies) used unique exclusion definitions, and 100% (27 out of 27 studies) used unique discharge definitions; this extreme heterogeneity was present across study designs, including randomized trials.
• Thematic analysis showed that most studies shared core underlying concepts, such as age, weight, and anesthesia risk classification, but the specific thresholds for each varied widely.
• Same-day discharge success rates in 25 nonregistry studies ranged from 63% to 100% (weighted mean, 94%); however, this range reflected differences in how strictly studies defined readiness for discharge rather than true differences in feasibility or safety.
• Reported 30-day safety outcomes varied widely and could not be pooled: Readmission rates ranged from 0% to 20.8% (38 study entries), mortality rates were 0% in randomized trials, up to 0.8% in cohort studies, and up to 0.12% in registries, and anastomotic or staple line leak rates ranged from 0% to 5.6% (24 study entries).

IN PRACTICE

“The path forward requires collaborative efforts through international surgical societies (ASMBS [American Society for Metabolic and Bariatric Surgery], IFSO [International Federation for the Surgery and Other Therapies for Obesity], EAES [European Association for Endoscopic Surgery]) to establish consensus-based standardized criteria — separately for sleeve gastrectomy and anastomotic procedures — covering patient selection, discharge definitions, and outcome reporting,” the authors of the study wrote.

“Centers implementing same-day discharge should adopt standardized definitions when possible, document deviations when necessary, and maintain rigorous quality improvement databases,” they added.

SOURCE

The study was led by Mohamed Hany, Alexandria University, Alexandria, Egypt. It was published online in Obesity Surgery.

LIMITATIONS

The researchers could not perform a meta‑analysis; therefore, they could not produce pooled safety estimates. Not every study reported all outcomes, so the available data varied across studies. Publication bias was likely because the majority of cohort studies came from single centers with established same-day discharge programs, while centers that tried same-day discharge protocols and stopped after having safety concerns or logistic problems probably did not publish their findings.

DISCLOSURES

The study did not report any funding source, and the authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.