Bariatric surgery on an outpatient basis: Our experience in a regional hospital centre and key pitfalls to avoid for enhanced success

Abstract Objective: This study evaluates the feasibility and safety of outpatient management for bariatric surgery, specifically sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), within a regional hospital centre in France. It compares outcomes with existing literature and aims to identify factors affecting the success of the outpatient approach. Patients and Methods: An observational, retrospective study was conducted from January 2019 to May 2024, analysing 69 outpatient bariatric surgery patients. The inclusion criteria followed the HAS guidelines. The study assessed demographic data, post-operative conversion to inpatient hospitalisation and its determinants. Results: The average patient age was 36.4 years, with a predominance of females (88.4%) and an average body mass index of 40.7 kg/m 2 . Outpatient procedures included 52 SGs and 17 RYGBs. Conversion to inpatient hospitalisation occurred in 29% of the patients due to issues of unrelieved pain and food intolerance. Eight patients visited the emergency department postoperatively and seven patients required readmissions for complications. No mortality was reported. Mild obstructive sleep apnoea was independently associated with increased odds of conversion to inpatient hospitalisation (adjusted odds ratio [OR]: 3.91, 95% confidence interval [CI]: 1.02–15.00), while increasing age was associated with decreased odds (adjusted OR: 0.93 per year, 95% CI: 0.87–0.99). Discussion: Outpatient bariatric surgery, particularly for selected patients, is generally feasible and safe. However, the study observed a higher conversion rate compared to other centers, attributed to patient selection, pain management and post-operative complications. Effective pre-operative evaluation, refined patient selection, improved post-operative care, patient education on pain and expectations are crucial for optimising outcomes. Conclusion: Outpatient bariatric surgery can be successful with expert surgical and anaesthetic management, proper patient selection and rigorous post-operative protocols.