ABSTRACT
Introduction
Sleeve gastrectomy (SG) is a prevalent bariatric surgery for obesity and related disorders. It combines restrictive and metabolic effects, affecting hormonal mechanisms contributing to weight loss. Multiple SG methods, including Laparoscopic Echelon (0-Strips), Laparoscopic Echelon with Peri-Strips (Echelon), da Vinci Surgical Robot assistance (Robot), and Laparoscopic Titan SGS device (Titan), exist. Associated costs are inadequately studied, impacting healthcare expenses and surgical group profitability. This study investigates these methods on procedural costs, surgery duration, and 30-day outcomes.
Methods
265 patients underwent SG between 2022 and 2023, each performed by a single surgeon. Post-operative weight loss, 30-day complications and side effects were monitored. Costs encompassed surgical supplies and operating room costs. Statistical analysis employed ANCOVA while controlling for possible confounding variable of intraoperative paraoesophageal hernia repair.
Results
The baseline characteristics across groups were similar, except for a lower prevalence of PEH in the Robotic group (p = 0.0385, E v. R). The average cost for Echelon, Robotic, Titan, and 0-Strips procedures are $3,939.35, $4,227.24, $3,531.84, and $3,800.26 respectively. All differences in cost are significant. The average surgery duration for Echelon, Robotic, Titan, and 0-Strips procedures are 1:34, 1:58, 1:20, and 1:41 respectively. Differences in surgery duration between Echelon/Robot (p < 0.0001), Echelon/Titan (p = 0.0178), Robot/Titan (p < 0.0001), and Robot/0-Strips (p = 0.0064) are significant only. The Titan and 0-Strips have the shortest surgery duration, with no significant difference between the groups (p = 0.0779). Statistical analysis
shows distinct cost and time differences among methods. Titan displayed the most cost-effective and time-efficient results. Surgical outcomes largely did not differ among methods, except for an anomaly of increased weight loss with Titan at one year. A cost-effectiveness equation model was applied for fixed reimbursement.
Discussion
The goal of a surgery group is to maximize profit by keeping intraoperative prices low and having as many daily surgeries as safely possible. An equation modeling daily profitability was developed, and it established time and cost saving superiority for the Titan and 0-Strip methods using a hypothetical fixed reimbursement rate. This remains true with and without consideration of operating room costs. Surgical groups with varying reimbursements can still benefit from these models to help decrease healthcare related spending as well as improve patient safety by minimizing duration of anesthesia.
Conclusion
The results suggest adopting Titan and 0-Strips methods for SG to enhance profitability and lower healthcare costs. The da Vinci Surgical Robot may not offer substantial benefits. Echelon staplers with strips showed increased costs without better outcomes. Further research is