Supplementary Material for: Cost-minimization study of glue versus sutured mesh fixation in laparoscopic sacrocolpo(recto)pexy.

Objectives: To conduct a cost-minimization analysis of laparoscopic sacrocolpo(recto)pexy (LSCP) using either synthetic glue or sutures alone for mesh fixation. Design: A cost-minimization study comparing two single-center consecutive cohorts (n=20 each), evaluating differences in consumables and operating room costs for laparoscopic sacrocolpo(recto)pexy, performed either with sutures alone or synthetic glue for mesh fixation (January 2021 to December 2021). Participants: All patients underwent LSCP using the same standardized technique performed by one of two gynecologic surgeons experienced in LSCP (≥50 procedures per year), both proficient in using sutures or glue for LSCP, to minimize any learning curve bias. Methods: Consumables costs associated with mesh fixation were prospectively recorded. Additional patient data were extracted from the electronic medical record. Statistical analysis was performed using GraphPad Prism. The chi-square test or t-test were applied as appropriate, with a significance level set at p < 0.05. Results In the sutures-only group, consumables costs were €194.54 ± 38.76, compared to €298.16 ± 31.59 in the glue group (p < 0.0001; 95% CI [81.80, 125.4]). The mean procedure time was significantly shorter in the glue group (34.6 ± 6.2 minutes vs. 51.3 ± 12.7 minutes; p < 0.0001; 95% CI [-23.19, -10.21]), reducing operating room maintenance costs by 32% (€477.22 ± 85.63 vs. €707.22 ± 175.14). Based on the consumables and operating room maintenance costs (€826.35 per hour) and time usage, the sutures-only method cost €901.76 ± 171.97 compared to €775.37 ± 86.62 for the glue group. In our setting, this translates to a cost saving of €126.39 per patient (-14%) when using glue (p < 0.0001; 95% CI [-214.6, -38.19]). Limitations The numbers above are specific to our setting. Our findings are also specific to laparoscopic approaches and cannot be directly applied to robotic sacrocolpopexy, as suturing times and operating room maintenance costs would differ significantly. Conclusions Using synthetic glue for mesh fixation increases consumables costs but reduces procedure time, resulting in overall cost savings that favor glue-based mesh fixation. These findings align with previous studies demonstrating reduced operation times with the use of glue. Our study is the first to formally assess and compare the costs of both techniques. We believe the overall cost saving is widely generalizable. To calculate the local impact, one can use the proportional differences reported here and substitute local consumables and operating room costs.