The Evaluation of Surgical Stapling in Robotic Thoracic Procedures: Clinical Outcomes and Resource Utilization

OBJECTIVES: This study compares clinical outcomes (CO) and resource utilization (RU) based on the types of staplers used in robotic thoracic procedures.

METHODS: Patients who underwent robotic thoracic elective procedures between 1/1/2021 and 12/31/2022 were extracted from PINC AI™ Healthcare Data. We included patients who used studied staplers, had all key variables, and had non-zero costs. CO was measured by blood transfusion, bleeding, air leak, pneumothorax, and bronchopleural fistula. RU included operating-room time (ORT), inpatient costs (in 2022 USD), and length of stay (LOS). The covariates to model and adjust CO and RU included types of stapling techniques (manual/intelligent bedside (MIBS) vs robotic (RS)) and baseline patient and provider characteristics. We evaluated baseline balance in MIBS and RS and bivariate association between covariates and CO/RU using Chi-square or Fisher exact test, and t-test or ANOVA. Multivariable general-linear-mixed models with respective gamma or binomial distribution and log-link function were used to obtain adjusted CO/RU variations between MIBS and RS. A sensitivity analysis was done using a propensity score matching analysis.

RESULTS: 4779 discharges were eligible, including 15.6% MIBS and 84.4% RS cases. All covariates were imbalanced between MIBS and BS cases except for patients' age, payer status, and providers’ location. After adjusted baseline variation, the adjusted outcomes showed that the RS was significantly more likely to have bleeding (Odds ratio: 1.9(95% confidence interval:1.2, 3.0, p=0.003), with $4,331 ($3,362, $5,301) increased costs and additional 19 minutes (12.3, 25.7) ORT compared to MIBS. Also, MIBS have equivalent adjusted rates of blood transfusion, air leak, pneumothorax, and LOS to RS. Sensitivity analysis showed similar results. (RS to MIBS: bleeding: 2.5 odds (1.6,3.9); increased cost: $5,464($3,885,$7,043); increased ORT 21.6 minutes (11.7,31.6)). All p-value <0.001.

CONCLUSIONS: MIBS used in thoracic robotic procedures are as effective as RS, resulting in less bleeding, cost savings, and more efficiency compared to robotic staplers.