OBJECTIVES: A recent meta-analysis of staple line complications (SLC) in primary bariatric/metabolic procedures covering 253 studies and 66,727 unique patients showed significantly lower (p<0.05) SLC rates for bovine pericardium (BP; Baxter Healthcare, Deerfield, IL) compared to biocompatible glycolide copolymer buttress (BGCB; W.L. Gore & Associates, Inc, Flagstaff, AZ), suture reinforcement, and no reinforcement. The aim of this study is to assess the impact of staple line reinforcement (SLR) choice on costs and outcomes of primary gastric bypass (GB) and sleeve gastrectomy (SG) from the Mexico Public Healthcare perspective.

METHODS: The cost-consequence model assesses BP vs. BGCB, suture reinforcement, or no reinforcement. Complication rates (leaks, bleeds) and operating room (OR) time are literature-based. For BP and BGCB, product volume per procedure is from the PREMIER US Database 2017 and acquisition costs are US average sales price. Cost of complications, OR time and oversewing are estimated from the Mexican Social Security Institute (IMSS). Annual outcomes are calculated assuming 86% GB procedures in Mexico. One-way sensitivity analyses using 95% confidence intervals or +/-20% and probabilistic sensitivity analyses (PSA) using Monte Carlo simulation for 5000 iterations evaluate key drivers of costs. Currency is reported in 2018 US dollars.

RESULTS: For hospitals in Mexico conducting 100 primary bariatric/metabolic procedures annually, using BP for all procedures could lead to 3 fewer complications and reduce surgical time by 99 hours. The net annual cost savings from hospital resource utilization would be $96,481 (OR hours=$69,700; complications=$68,146; product acquisition=-$41,366) or $436, $1,494, $937 per procedure switching from BGCB, suture reinforcement, and no reinforcement, respectively. The PSA estimate of the 95% confidence interval for overall annual cost savings is $65,835 to $133,367.

CONCLUSIONS: Based on complications, OR time and product cost, resource utilization savings are over 3 times greater than product acquisition cost when using BP for SLR in Mexico.