Background

Quality of metabolic and bariatric surgery [MBS] continues to improve, but few studies have examined cost of MBS. Our study assessed different costs and outcomes in Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB).

Methods

We conducted a clinical optimization cost reduction study after SG or RYGB from June 2018 to August 2020 at two MBSAQIP centers of excellence. Cost saving measures included reduction or elimination of staple line reinforcement, Endo-stitch suturing device, changed energy devices and endoscopic staplers. Mean cost of SG was used as standard for comparison [1.0], cost of RYGB was calculated as compared to the mean cost of SG.

Results

1258 patients were included with 659 in the control group and 599 in the intervention group. Overall demographics and comorbidities were equal among groups. RYGB cost was more than SG [1.65 vs 1.0 P<0.0001] and there was larger variability in the cost of RYGB compared to SG between surgeons [Circular most expensive followed by linear with Hand-sewn least expensive, P<0.0001]. After cost reduction, significant reduction in staple line reinforcement [SLR] was seen in SG P<0.0001 and reduction in SLR P<0.0001, stapler reloads P<0.0001 and staplers in RYGB P<0.0003. No significant differences were noted between groups for complications or readmissions in SG and RYGB.

Conclusions

SG costs less than RYGB and there is more variability in cost in RYGB [circular most expensive and hand-sewn least expensive]. Most significant cost reduction was noted in staple line reinforcement [SLR] in SG and SLR and stapler cost in RYGB.