Costs of Leaks and Bleeding After Sleeve Gastrectomies

Background: Leaks and bleeding are serious postoperative complications after a sleeve gastrectomy (SG). The objective of the present study was to evaluate the costs of leaks and bleeding after SG.

Methods: A retrospective analysis was conducted of a prospective cohort of primary SGs between August 2006 and September 2013 in a bariatric center. All SGs were performed consistently without reinforcement of the staple line. Abscesses adjacent to the staple line were also regarded as leaks. Data were collected on all diagnostic and therapeutic measures necessary to manage leaks or bleeding, days of hospitalization and parenteral feeding, number of blood products, antibiotics, and additional outpatient department visits.

Results: One thousand two hundred sixty one patients underwent a SG. Leaks occurred in 32 (2.5%) and bleeding in 27 (2.1%) patients. Median additional costs for leaks were <euro>9284 (range <euro>1748-125,684) and <euro>4267 (range <euro>1524-40,022) for bleeding. Prolonged hospitalization in the ward and ICU accounted for the majority of costs, 50.3 and 31.4%, respectively, for leaks and 42.0 and 34.8% for bleeding.

Conclusions: These data provide insight into the costs of major complications after SG. A wide range is seen especially due to prolonged hospitalization in the ward and ICU. High costs are an additional argument to reduce complication rate. These data should be considered when analyzing the cost-effectiveness of staple line reinforcement.