Comparative safety of same-day discharge with remote monitoring after laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass: a systematic review and meta-analysis

Abstract

Background: Bariatric surgery, primarily laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is an effective treatment for obesity. As the demand for healthcare increases, same-day discharge (SDD) supported by remote monitoring (RM) is being explored to optimize resources without compromising safety. This systematic review and meta-analysis aimed to evaluate the safety and clinical outcomes of SDD with RM for primary bariatric surgery.

Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and PROSPERO registration (CRD420251124540), a comprehensive search was conducted across PubMed, Scopus, and Web of Science. Six observational studies involving 1581 patients (LSG: 1164; LRYGB: 417) met the inclusion criteria. Outcomes included pooled readmission and complication rates, which were analyzed using a generalized linear mixed model.

Results: The overall pooled readmission rate for the RM subgroup was 3.35% (95% CI, 2.57%-4.36%). Subgroup analysis revealed a significantly lower readmission rate for LSG (2.66%) than for LRYGB (5.28%, P = .012). Major complications (Clavien-Dindo grade ?3) were rare at 1.58% and were comparable between procedures. The overall complication rate was 3.80%. Meta-regression indicated that surgery type was not a significant moderator for major or overall complications, suggesting that the higher readmission rate for LRYGB was largely driven by manageable functional issues, such as dehydration.

Conclusion: Both LSG and LRYGB appear to have favorable safety profiles in an outpatient setting with RM, with LSG demonstrating an advantage of significantly fewer readmissions in the early postoperative period.