ArticleSurgical endoscopy2026
Do structural ICU requirements reflect critical care demand in elective metabolic and bariatric surgery? A retrospective cohort study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMetabolic and bariatric surgery (MBS) is increasingly delivered in lower-acuity settings, yet on-site intensive care unit (ICU) capability remains a structural requirement for the highest center-designation tier. Direct data on critical-care utilization after elective MBS without an on-site ICU are limited. We describe 30-day outcomes at such a center, using contemporaneous elective laparoscopic cholecystectomy (LC) in the same environment as a reference.
methodsRetrospective cohort study of consecutive adults undergoing elective MBS (sleeve gastrectomy or Roux-en-Y gastric bypass) or LC (2022-2025) at a single center without an on-site ICU but with a pre-defined escalation and transfer protocol. The primary outcome was the 30-day complication rate (Clavien-Dindo); ICU utilization was grade ≥IV. Outcomes are reported descriptively with 95% confidence intervals (CIs); regression and propensity-score-matched analyses are exploratory (Supplementary Material).
resultsOf 1,065 patients (MBS n=351, LC n=714), 30-day complication rates were 4.27% (95% CI 2.39-6.94%) versus 3.64% (95% CI 2.37-5.27%). No MBS patient was admitted to intensive care (0/351), compatible with a true rate up to 1.05% (upper 95% CI); two LC patients required ICU admission (0.28%), both for retained-stone acute pancreatitis. All five MBS reoperations were for postoperative hemorrhage; none developed organ dysfunction or met ICU-transfer criteria, and none died. Because events were rare, this study cannot exclude clinically meaningful ICU demand, and absence of a detected difference does not establish equivalence.
conclusionsIn this single-center experience, elective MBS without an on-site ICU under a structured escalation protocol showed no observed ICU admissions over 30 days, though the confidence interval remains compatible with infrequent critical-care need. These hypothesis-generating findings demonstrate feasibility in one environment and should not be generalized to accreditation policy; prospective multicenter data are required. STUDY REGISTRATION: Research Registry (UIN: researchregistry11829); retrospectively registered; https://www.researchregistry.com.
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