OBJECTIVES: Surgeons often use buttress material to reinforce staple lines as a preventive measure against potential surgical leaks and bleeding. This study evaluated the clinical and economic outcomes associated with staple line buttress among patients undergoing sleeve gastrectomy.

METHODS: Using the Premier Healthcare Database of US hospital discharge records, this study included patients who underwent a primary laparoscopic sleeve gastrectomy from 4/1/2012-9/30/2017. The following clinical and economic outcomes were compared between patients with and those without use of buttress: bleeding/transfusion, leak, hospital length of stay (LOS), operation room (OR) time, and costs (total hospitalization, OR, room and board, and supply). Propensity score matching (PSM) was used to adjust for patient and hospital characteristics differences. Generalized estimating equations accounting for hospital-level clustering in the matched population were conducted to compare outcomes between patients with and those without buttress use.

RESULTS: The study included 38,231 patients with buttress use, and 27,349 patients without. Staple line buttress was associated with a 24% lower rate of bleeding (1.37% vs 1.80%, p=0.015), 28% lower rate of transfusion (0.56% vs 0.77%, p=0.050), and similar rate of leak (0.28% vs 0.39%, p=0.160) during the index hospitalization. Patients with use of buttress also had similar hospital LOS (1.75 days vs 1.74 days, p=0.718) and OR time (3.31 hours vs 3.42 hours, p=0.644) as compared with patients without buttress use. Total hospital costs were 11% higher for patients with buttress use ($12,201 vs 10,986; p<0.001); medical/surgical supply costs ($5,366 vs $4,320; p<0.001) were the main cost driver. OR ($4,156 vs $3,983, p=0.132) and room and board costs ($1,083 vs $1,075; p=0.793) were similar between patients with and those without buttress use.

CONCLUSIONS: Among patients undergoing sleeve gastrectomy, staple line buttress use was associated with lower bleeding/transfusion rate, but higher hospital costs mainly due to the supply costs.