Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Abstract

Aims: To compare economic and clinical outcomes between patients undergoing laparoscopic Rouxen-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers. Materials and methods: Patients (aged !21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012-September 30, 2015 were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions. Results: The powered and manual stapler groups comprised 9,851 patients (mean age ¼ 44.6 years; 79.3% female) and 21,558 patients (mean age ¼ 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p ¼ .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p ¼ .003), adjusted mean supply costs ($4,629 vs $5,217, p ¼ .011), and adjusted mean operating room costs ($4,126 vs $4,413, p ¼ .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p ¼ .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results. Limitations: This observational study cannot establish causal linkages. Conclusions: In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.ARTICLE HISTORY

<p>The Impact of Endoscopic Stapler Selection on Bleeding at the Vascular Stump in Pulmonary Artery Transection</p>

“…Powered endoscopic staplers reportedly lead to fewer bleeding events during pulmonary vessel transection than manual endoscopic staplers due to increased stability during firing. 3,4 Miller et al also found that powered staplers demonstrate superior results in reduced total hospital length of stay and total hospital cost in addition to bleeding management; however, this study was limited by differences in patient characteristics and different approaches in multiple centers and/or surgeons' experience, making it difficult to draw clear conclusions about the full benefits of powered versus manual staplers. 4 Our results, from a single center, demonstrate that tremors during firing may not be the leading cause of bleeding during vessel transection.…”

“…Results from a real-world study on laparoscopic bariatric surgery found ECHELON powered staplers were associated with a 47% lower rate of bleeding complications versus Medtronic Endo-GIA TM with Tri-Staple TM Technology and other manual staplers. 3 Additionally, in vivo experiments in a gastrointestinal porcine model reported A B C Figure 1 (A) Comparison of powered endoscopic staplers (B) comparison of jaw angles and (C) histological findings after pulmonary arterial stapling. Histological sections of pulmonary artery tissue adjacent to the area of stapling were stained with Elastica van Gieson stain (X200).…”

“…2 Powered staplers incorporate a motor to power both staple firing and the cutting action of the blade. By reducing movement at the distal tip up to 88% versus manual staplers, powered staplers minimize the impact of surgeons' hand tremors during firing; 3,4 this reduces trauma to adjacent tissue and potential instances of bleeding. Expert consensus regarding endoscopic stapling in thoracic surgery is that improved device stability could reduce surgeons' stress and prevent unintentional tissue damage during surgery.…”

Anticoagulant activity of enoxaparin and unfractionated heparin for venous thromboembolism prophylaxis in obese patients undergoing sleeve gastrectomy

“…Even within the same surgical procedure, technique may also influence bleeding. For example, less bleeding was observed in 1 study with the use of a powered versus automatic stapler in bariatric surgery [38] . The difference in result may also be related to the definition of bleeding used between studies.…”

A novel powered circular stapler designed for creating secure anastomoses

“…Powered linear staplers have been shown to consistently produce fewer malformed staples [5,6]. The advantage of power has been shown to carry over to superior performance clinically [7][8][9][10][11] and even provide an economic benefit [12].…”