Single-center bariatric surgery cohort reports no ICU admissions, with uncertainty about rare events

A retrospective single-center study in Surgical Endoscopy examined 30-day outcomes after elective metabolic and bariatric surgery at a facility without an on-site intensive care unit (ICU). The center used a predefined escalation and transfer protocol. Consecutive adults undergoing sleeve gastrectomy or Roux-en-Y gastric bypass during 2022–2025 were compared descriptively with contemporaneous elective laparoscopic cholecystectomy patients. The primary outcome was the 30-day Clavien–Dindo complication rate; ICU utilization was classified as grade IV or higher.

Among 1,065 patients, complication rates were 4.27% in the bariatric group (351 patients; 95% CI 2.39–6.94%) and 3.64% in the cholecystectomy group (714 patients; 95% CI 2.37–5.27%). No bariatric patient required ICU admission, although the upper 95% confidence limit was 1.05%. Two cholecystectomy patients required intensive care (0.28%), both for retained-stone acute pancreatitis. All five bariatric reoperations were for postoperative hemorrhage; none of these patients developed organ dysfunction, met ICU-transfer criteria, or died.

The findings suggest feasibility in this specific setting under a structured escalation protocol, rather than demonstrating that on-site ICU capability is unnecessary. Rare events, the retrospective single-center design, and retrospective registration limit interpretation. Absence of a detected difference does not establish equivalence. The authors call for prospective multicenter data before generalizing findings to accreditation policy.