Short-term economic impact of early leaks following metabolic bariatric surgery

Abstract Background Despite its low incidence, leaks result in high morbidity and represent the second cause of death after metabolic bariatric surgery (MBS). The economic impact of diagnosing and managing early leaks after MBS was assessed within the Spanish Health System. Method A cost analysis model was developed to estimate the resource consumption of patients with early leaks after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Through a comprehensive literature review, an epidemiological framework was established to estimate the incidence of early leaks. Patients were classified into fourteen scenarios based on the type of MBS performed, initial management of the early leak (conservative, endoscopic and/or surgical), and the need for a secondary treatment. Resource consumption over a one-year time horizon was collected based on clinical practice, and unit costs in year 2025 were obtained from national databases. All parameters were validated by a panel of experts, and sensitivity analyses were conducted to assess the robustness of the results. Results Total costs of early leaks reached €4,199,549, including €3,469,303 after LSG (82 events/year) and €730,246 after LRYGB (18 events/year). The cost per patient with an early leak after LSG ranged from €13,358 to €94,532, with a weighted average cost of €42,285 and after LRYGB from €13,110 to €94,284, with a weighted average cost of €40,971. Hospital stays and health procedures represented the highest cost. The sensitivity analysis results ranged between €1,189,220- €7,209,878. Conclusions Early leak after MBS markedly increased health resource utilization, mainly due to an increase in hospitalizations, with cost increase associated with the complexity of the event.