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

Despite their 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.

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 14 scenarios based on the type of MBS performed, the initial management of the early leak (conservative, endoscopic, or surgical ± endoscopic), and the need for a secondary treatment. Resource consumption over a 1-year time horizon was determined based on clinical practice, and unit costs in 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.

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 mean cost of €42 285, and the cost per patient with an early leak after LRYGB ranged from €13 110 to €94 284, with a weighted mean cost of €40 971. Hospital stays, as well as procedures and interventions, accounted for the largest share of costs. The sensitivity analysis results ranged between €1 189 220 and €7 209 878.

Early leaks after MBS markedly increase health resource utilization, mainly due to an increase in hospital stays, with costs increasing in line with case complexity.