Safety Outcomes in Same-Day Discharge Anastomotic Metabolic/Bariatric Surgery vs Regular Overnight Discharge Protocol: A Systematic Review and Meta-analysis.

Same-day discharge (SDD) protocols for anastomotic metabolic and bariatric surgery (MBS) have emerged as a strategy to optimise healthcare resources. However, concerns regarding safety, particularly related to mortality and postoperative complications, remain unresolved. This meta-analysis aimed to compare the safety of SDD with standard overnight hospitalisation (OH) in anastomotic MBS, focusing on early postoperative outcomes. A systematic review and meta-analysis were conducted following PRISMA and MOOSE guidelines. Four studies, including 19,849 patients (24.4% undergoing SDD), were analysed. Outcomes assessed included 30-day overall morbidity, mortality, readmission, reoperation rates and complications categorised by the Clavien-Dindo classification. A random-effects model was used for data pooling, and heterogeneity was assessed using the I statistic. SDD was associated with a significantly higher risk of 30-day mortality (OR 7.24; 95% CI 2.27-23.52; p = 0.001; I = 26%) and overall morbidity (OR 1.89; 95% CI 1.29-2.76; p = 0.001; I = 4%) compared to OH. No significant differences were observed in readmission (OR 1.17; 95% CI 0.61-2.22; p = 0.64; I = 79.1%) or reoperation rates (OR 0.98; 95% CI 0.47-2.03; p = 0.96; I = 61%). Interestingly, SDD was associated with a significantly lower rate of major complications (Clavien-Dindo grade III/IV) compared to OH (OR 0.64; 95% CI 0.44-0.91; p = 0.013; I = 9%). The observed increase in mortality and morbidity among SDD patients underscores the need for stringent patient selection, standardised discharge protocols and robust follow-up systems. Prospective studies are required to refine SDD protocols and ensure their safe implementation.