Feasibility and Safety of Ambulatory Bariatric Surgery in a High-Volume Center: A Comparative Study with Inpatient Procedures

Background Ambulatory bariatric surgery has emerged as a safe and efficient alternative to traditional inpatient care when performed in carefully selected patients within structured enhanced recovery programs. The implementation of Enhanced Recovery Protocols (ERPs) protocols has enabled significant reductions in length of stay, postoperative morbidity, and healthcare costs without compromising patient safety. However, limited data are available from Latin American high-volume centers. Objectives To compare the feasibility and safety of ambulatory versus inpatient bariatric surgery in patients operated between 2017 and 2022 at a high-volume specialized bariatric center in Buenos Aires, Argentina. Methods A retrospective comparative study including all consecutive bariatric procedures performed from January 2017 to December 2022 (N = 2505). Patients were divided into an inpatient group (n = 1713) and an ambulatory group (n = 792). A 1:1 matched-pair analysis (sex, age, BMI, preoperative weight loss, comorbidities, and procedure type) generated 313 patients per group. Primary outcomes were major complications, 48hr-readmissions, and 30-day reoperations. Statistical significance was set at p < 0.05. Results Major complications occurred in 1.9% of ambulatory patients versus 4.2% of inpatients (p = 0.161). Readmission rates were 1.9% and 2.6%, respectively (p = 0.788), and reoperation rates 0.6% versus 1.6% (p = 0.450). No mortality occurred. The success rate for same-day discharge among eligible patients was 98.0%. Conclusions Ambulatory bariatric surgery, within Enhanced Recovery Protocols (ERPs) and strict patient selection, is feasible and safe in a high-volume Latin American center, showing comparable outcomes to inpatient surgery while reducing hospitalization demands and healthcare costs.