Is same-day discharge after bariatric surgery safe? A national MBSAQIP analysis.

BACKGROUND: Same-day discharge (SDD) following bariatric surgery has gained interest due to potential cost savings, but concerns remain regarding its safety compared with short postoperative observation. OBJECTIVES: To evaluate the association between discharge timing and 30-day mortality and serious postoperative complications following bariatric surgery. SETTING: United States METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database (2015-2019) was analyzed. Adult patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were included. Discharge timing was categorized as same-day (postoperative day 0), outpatient (postoperative day 1), or inpatient (>1 day). Patient characteristics were compared using Kruskal-Wallis and χ2 tests. Multivariable logistic regression adjusted for demographic, clinical, and operative factors evaluated associations between discharge timing, 30-day mortality, and serious complications (Clavien-Dindo grade ≥ III). RESULTS: Across both RYGB and SG cohorts, outpatient discharge was associated with significantly lower odds of mortality and serious complications compared with SDD. After adjustment, outpatient discharge demonstrated a 75% reduction in mortality and a 60% reduction in serious complications for RYGB (P ≤ .0005), and a 58% reduction in mortality and 35% reduction in serious complications for SG (P ≤ .002). Compared with SDD, inpatient discharge was associated with lower mortality after RYGB but showed no mortality difference after SG, while SG inpatients had higher odds of serious complications. CONCLUSIONS: SDD after bariatric surgery was associated with higher mortality and serious complication rates compared with next-day outpatient discharge. Brief postoperative observation may provide a safer risk profile across bariatric procedures.