A Comparative Effectiveness Study of Two Narrow Profile Staplers Used in Video-Assisted Thoracoscopic Surgery Lobectomy

OBJECTIVES: This study evaluates the effectiveness of two narrow-profile vascular staplers on patients treated with video-assisted thoracoscopic surgery (VATs) lobectomy.

METHODS: Patients who underwent VATs lobectomy between 1/1/2021 and 12/31/2022 were extracted from PINC AI™ Healthcare Data. We included elective patients who used studied staplers and had all key variables. The effectiveness of outcomes was measured by blood transfusion and bleeding. Propensity score (PS) matching method was used to match patients with small diameter reload (SDR) to those with powered vascular staplers (PVS). Based on existing literature, PS was calculated by age, gender, marital status, race, payer, diagnosis, and comorbidity. We performed 1:1 nearest neighbor matching for SDR (treated) and PVS (controlled) with a caliper of 0.2. The Chi-square or Fisher exact test was used to examine the effectiveness of post-matched cases. Sensitivity analysis was performed using multivariable logistic regression analysis.

RESULTS: 467 inpatient procedures were eligible, including 35.8% SDR and 64.2% PVS cases. After PS matched, most patients were age >= 65 (62.9%), female (66.2%), married (58.0%), non-Hispanic White (86.5%), with Medicare (62.3%), lung cancer diagnosis (85.0%), and had more than three Charlson comorbidity scores (63.2%). The standard difference in patient characteristics of 167 pairs cases was under 0.08 after PS matched. Post-matched analysis showed that the SDR group is significantly less likely to have a blood transfusion than the PVS group. (Incidence rate SDR vs. PVS: 0.6% vs. 4.8% (p-value = 0.037)) and no difference in bleeding rates between the two groups. (p= 0.28). Sensitivity analysis showed similar results: blood transfusion rates: SDR vs PVS: 0.6% vs 5.1% (p-value = 0.031). Bleeding rates are insignificant differences between the two groups. (p-value = 0.14).

CONCLUSIONS: The study confirmed that SDR effectively divided pulmonary vasculature, with fewer blood transfusions than PVS and added access benefits due to its narrow profile.