Same-Day Discharge After Sleeve Gastrectomy in Older Patients Years Leads to Higher Rates of Dehydration

Suh S, Yang K, Chunara F, et al. Safety of Same-Day Discharge after Sleeve Gastrectomy in Adults 65 Years and Older. J Am Coll Surg. September 16, 2025.

Using 2022 data from the ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, study authors identified 4,609 patients aged ≥65 years who underwent primary minimally invasive sleeve gastrectomy. 310 were same-day discharges (SDD) and 4,299 were discharged on postoperative day 1. 

Although the SDD cohort had fewer comorbidities, outcomes showed higher rates of wound disruption, dialysis-requiring acute renal failure, and greater use of outpatient intravenous fluids (IVF) administration. After 1:1 propensity matching and regression adjustment, the dehydration signal persisted showing, outpatient IVF administration remained higher with SDD (4.8% vs. 0.97%; p = 0.005) while rates of readmission, emergency department visits, reoperation, and major adverse events were comparable.

For bariatric surgeons, SDD in patients ≥65 is potentially feasible but should be paired with explicit safeguards against dehydration. Practical steps include tighter patient selection, standardized antiemetic and hydration pathways, scheduled fluids, and a low threshold for clinic/infusion visits. Remote monitoring can help detect fluid deficits early. In settings without ready access to outpatient infusions or navigation, a planned overnight stay may prevent avoidable complications.