<p>Same-day discharge (SDD) protocols for anastomotic metabolic and bariatric surgery (MBS) have emerged as a strategy to optimise healthcare resources. However, concerns regarding safety, particularly related to mortality and postoperative complications, remain unresolved. This meta-analysis aimed to compare the safety of SDD with standard overnight hospitalisation (OH) in anastomotic MBS, focusing on early postoperative outcomes. A systematic review and meta-analysis were conducted following PRISMA and MOOSE guidelines. Four studies, including 19,849 patients (24.4% undergoing SDD), were analysed. Outcomes assessed included 30-day overall morbidity, mortality, readmission, reoperation rates and complications categorised by the Clavien-Dindo classification. A random-effects model was used for data pooling, and heterogeneity was assessed using the <i>I</i>² statistic. SDD was associated with a significantly higher risk of 30-day mortality (OR 7.24; 95% CI 2.27–23.52; <i>p</i> = 0.001; <i>I</i>² = 26%) and overall morbidity (OR 1.89; 95% CI 1.29–2.76; <i>p</i> = 0.001; <i>I</i>² = 4%) compared to OH. No significant differences were observed in readmission (OR 1.17; 95% CI 0.61–2.22; <i>p</i> = 0.64; <i>I</i>² = 79.1%) or reoperation rates (OR 0.98; 95% CI 0.47–2.03; <i>p</i> = 0.96; <i>I</i>² = 61%). Interestingly, SDD was associated with a significantly lower rate of major complications (Clavien-Dindo grade III/IV) compared to OH (OR 0.64; 95% CI 0.44–0.91; <i>p</i> = 0.013; <i>I</i>² = 9%). The observed increase in mortality and morbidity among SDD patients underscores the need for stringent patient selection, standardised discharge protocols and robust follow-up systems. Prospective studies are required to refine SDD protocols and ensure their safe implementation.</p>