People who are actively researching bariatric surgery are often looking for answers to similar questions. One of them relates to whether or not bariatric surgery is an outpatient procedure. The short answer is that it’s not quite outpatient — but it’s close.
Defining “Outpatient”
We usually define “outpatient” procedures as those in which a person can come into the center or hospital, undergo a short procedure, stay for a brief period of observation, and then go home the very same day. The primary bariatric surgical procedures being done today require an overnight stay, so most people would not call this outpatient.
However, there is a little bit more to the story, of course. From a definitional point of view, some health insurance plans have changed their definition of outpatient to include overnight stays and things like 23-hour hospital stays. Some even will consider a 48-hour hospital stay as an outpatient category. This nomenclature nonsense has more to do with fights over money and reimbursement between health insurance plans, hospitals, and providers. If they categorize a procedure as outpatient, they may have a negotiated reimbursement rate that is lower than a more major, inpatient procedure. But for you and me — regular people considering surgery and doctors taking care of human beings, and not numbers, — we stick with the definition of outpatient as I have described above, which is synonymous with “same-day” surgery.
The Reason for Staying Overnight
The first widely performed same-day surgery was the Lap Band. This procedure was performed with four or five small laparoscopic incisions and could be performed in 45 minutes with the person going home the same day in most cases. The gastric sleeve is close to these same parameters but has a few different features, which usually require the overnight hospital stay. The gastric sleeve procedure is also done with four or five small Band-Aid type incisions, usually around a 45-minute procedure, and considered very safe and low risk. The reason that people do not just go home the same day most of the time is that the sleeve procedure involves removing over 50% of the stomach tissue. And while this is very safe, effective, and well-tolerated, in the short term, it can cause stomach upset, nausea, vomiting, and troubles taking in enough oral intake. For this reason, most of the time the gastric sleeve procedure is performed with an overnight hospital stay. There are exceptions, however. Some centers have become very adept at allowing selected individuals to go home if they are tolerating oral fluids. Additionally, centers can leave the IV catheter in place and arrange for the patient to return the following morning for some additional fluids, which buys time for the stomach to recover. Returning for fluids and medications daily can be orchestrated for several days if necessary and allows the person to go home and sleep in their own bed safely.
Gastric bypass surgery, which, prior to the sleeve, was the number one procedure performed worldwide, normally also requires at least an overnight hospital stay. The reasons are the same as those I have outlined above regarding the sleeve and oral intake of fluids, but with the additional concerns that the gastric bypass is more invasive and involves somewhat more complex surgical changes. While the risks are low, it is reassuring for both the patient and the surgeon that the vital signs and clinical picture look safe and sound after a night or two in the hospital prior to discharge.
In the future, we may see evolving procedures that are done as same-day surgery or outpatient procedures, although none are currently vying to replace the sleeve. We may also see improvements in the sleeve technique and in the treatment of nausea enabling better oral fluid intake after the gastric sleeve such that more people can go home the same day.
More questions about what bariatric surgery involves and whether you might be a candidate? Contact the team at Nevada Surgical today to learn more.
