title: Clinical and Economic Evaluation of Absorbable Staple Line Buttressing in Sleeve Gastrectomy in High-Risk Patients.
abstract: Gastric leaks and bleeding are the most important complications after laparoscopic sleeve gastrectomy (LSG). The use of absorbable membranes as staple line reinforcement may decrease this risk. On the other hand, these materials bring additional costs and their economic impact is not well known. The purpose of this study was to assess the clinical and economic performance of one of the commercially available buttressing absorbable materials when treating a high-risk population.
  
  
  
  A retrospective, observational, and comparative study was conducted at Montpellier University Hospital, France, between July 2013 and September 2014. Patients undergoing LSG, who were at a high risk for leaks and bleeding, were included and treated according to two groups: no buttressing (July 2013 to January 2014) and buttressing (February 2014 to September 2014). Clinical and economic outcomes were measured throughout the first 6 months.
  
  
  
  Two hundred two patients were included in the study: 116 during the no stapling reinforcement period and 86 during the buttressing period. Baseline characteristics were similar. There was no significant difference between the two groups regarding gastric leaks. However, buttressing reduced hemorrhagic complications (0 vs 8.6 %, p = 0.005) and decreased average total hospital costs for the first hospitalization (5768 vs 6025 €, p < 0.001), as well as 6-month total inpatient cost (5944 vs. 6246 €, p < 0.001).
  
  
  
  Staple line reinforcement with absorbable material reduces bleeding in high-risk population. Therefore, this type of material can also result in cost-savings.
authors.affiliation: CHU de Montpellier, Montpellier, France. xaviergayrel@hotmail.fr.
authors.forename: X
authors.initials: X
authors.lastname: Gayrel
authors.affiliation: CHU de Montpellier, Montpellier, France.|Universidade Positivo, Curitiba, Brazil.|Université Montpellier 1, Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Loureiro
authors.affiliation: CHU de Montpellier, Montpellier, France.
authors.forename: E M
authors.initials: EM
authors.lastname: Skalli
authors.affiliation: CHU de Montpellier, Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Dutot
authors.affiliation: CHU de Montpellier, Montpellier, France.|Université Montpellier 1, Montpellier, France.
authors.forename: G
authors.initials: G
authors.lastname: Mercier
authors.affiliation: CHU de Montpellier, Montpellier, France.|Université Montpellier 1, Montpellier, France.
authors.forename: D
authors.initials: D
authors.lastname: Nocca
mesh_terms: D020341:Absorbable Implants; D057868:Anastomotic Leak / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D005602:France; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D017792:Surgical Stapling / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D013537:Sutures; D015431:Weight Loss
keywords: Buttressing; Costs; Hemorrhage; High-risk patients; Leak; Sleeve gastrectomy