Bariatric Surgery Performed at a Tertiary Care Hospital and an Ambulatory Hospital: A 5 Year Comparison of Outcomes, OR Efficiencies and Costs

Purpose To explore change in 30-day post- operative complications, operative times, operating room (OR) efficiencies for bariatric surgery performed at a tertiary care hospital (TH) and an ambulatory hospital with overnight stay (AH) within one hospital network over 5 years; and to compare perioperative costs at the TH and AH. Materials and Methods We performed a retrospective analysis of existing data from a cohort of consecutive adult patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) between September 2016 and August 2021 at TH and AH. Results A total of 805 patients (762 LRYGB, 43 LSG) had surgery at AH, while 109 (92 LRYGB, 17 LSG) at TH. OR times for LRYGB and LSG performed at AH were significantly shorter versus TH ( 150 +/- 24 vs 178 +/- 51 min; p < 0.01) and (123 +/- 24 vs 147 +/- 34 min; p = 0.01). OR turnovers (19.2 +/- 6.0 min vs 28.1 +/- 6.1 min; p < 0.01) and Post Anesthetic Care Unit (PACU) times (2.4 +/- 0.6 h vs 3.1 +/- 1.5 h; p < 0.01) were significantly faster at AH versus TH. Proportion of patients requiring transfer for a complication from AH to TH remained constant over time (range 1.5-6.2%/year; p = 0.14). 30-day complication rates were similar between AH and TH (5.5-11% vs 0-15%; p = 0.12). LRYGB and LSG costs were similar between AH and TH (8,855 +/- 1,328CAD vs 8,799 +/- 2,729CAD; p = 0.91 and 8,763 +/- 1,449CAD vs 7,857 +/- 1,825CAD; p = 0.41). Conclusion There was no difference in 30-day post-operative complications for LRYGB and LSG performed at AH and TH. Performing bariatric surgery at AH has the benefit of improved OR efficiency without a significant difference in total perioperative costs.