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Routine post-sleeve gastrografin needless and not cost-effective

Wed, 06/17/2020 - 11:04
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Routine post-sleeve gastrectomy gastrografin (RSG) to detect post- laparoscopic sleeve gastrectomy (LSG) complications, especially leaks, is needless and unnecessarily increases the overall costs as it makes no difference in detecting leaks, according to researchers from Saudi Arabia.

The study, ‘Is routine post-sleeve gastrografin needed? Profile of 98 cases’, published in BMC Research Notes, sought to evaluate the cost-effectiveness of RSG by considering the cost of the study, length of hospital stay and complications-related costs RSG could prevent. The study authors reviewed bariatric patients’ data available in the database of the bariatric canter of King Fahd Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia (SA), where RSG is still performed for some patients based on the surgeon’s own experience and decision.

None of the eligible patients were found to have developed post-operative bleeding, obstruction or leak. Therefore, the paper presents and discusses the costs and length of hospital stay for the patients who underwent RSG vs those who did not, and offers a few observations from the patients’ demographic and anthropometric data.

From 149 screened patients, 98 were eligible with a mean age of 35 years (SD = 9.92) - 63.3% (n=62) were female and most patients were 26–35 years of age (n=39, 39.8%). Most of the female patients (n=30, 48.4%) were in the age group between 26 and 35 years, while most of the males (n=13, 36.1%) were between 18 and 25 years of age.

The mean preoperative weight and BMI of the sample were 120.19kg and 46.54, respectively. Females had a statistically significant lower mean preoperative weight (p=<0.001) and BMI (p=0.019) compared to males; the mean pre-operative weight and BMI for females were 110.08 kg and 44.41); and for males were 137.61 kg and 50.21, respectively. Of all 98 patients, 75.51% (n=74) had a preoperative BMI≥40 and 24.49% (n=24) had a preoperative BMI<40. The mean weight, BMI and percentage weight loss (PWL) six months post-operatively were found to be 87.71, 33.89 and 26.41%, respectively. Six months post-operatively, there was no statistically significant difference in mean BMI between females (33.67) and males (34.28).

The average overall cost, excluding the cost of the LSG procedure, was 5193.15 Saudi Riyal (1054.77 £) for those who underwent RSG and 4222.27 (857.58 £) for those who did not (p<0.001). Most patients (90.8%, n=89) stayed in hospital for 3 days except for 9.2% (n=9) that stayed for four days (n=4), five days (n=2), six days (n=2) or days days (n=1). The average length of stay (ALOS) was practically the same regardless of whether or not the patient underwent RSG.

All patients where medically free except for 24.49% of the patients (n=24) who had one or more medical comorbidities of hypothyroidism (n=16), diabetes mellitus (n=10), rheumatoid arthritis (n=3) and/or hypertension (n=1). Finally, none of the patients developed postoperative bleeding, stenosis or leak.

The authors summarised that for hospital stay, a typical duration of three days was found regardless of whether or not the patient underwent RSG and state that with medically free patients, who are not expected to have surgical complications, following a fast-track protocol would significantly decrease the overall cost.

“In conclusion, when LSG is performed as a primary bariatric procedure in obese patients, RSG is needless and would unnecessarily increase the overall cost as it makes no difference in detecting leak,” the authors concluded. “Also, a fast-track protocol in admitting patients for LSG and discharging them over two days or less would reduce the cost without affecting post-operative outcomes. Finally, the observation of favourable post-LSG outcome in males compared to females in terms of PWL in a Saudi sitting needs to be further investigated in future studies.”

To access this paper, please click here