Presentation (CTI)

OBJECTIVES: Evaluate the effectiveness of robotic SureForm staplers (RS) compared with laparoscopic bedside stapling (BS) in bariatric robotic procedures.
METHODS: The PINC AI™ Healthcare Database was used to extract patients who underwent robotic sleeve gastrectomy or gastric bypass procedures between 2019 and 2022. We employed a natural language processing (NLP) model and pattern matching searches to identify cases where each stapler type was used. Patient demographics, hospital characteristics, billing information, and operative details were captured. Outcomes compared included: length of stay (LOS), operating room (OR) time, organ surgical site infection (SSI), gastric leak, bleeding, blood transfusion, 30-day intensive care unit (ICU) visit, 30-day readmission, and 30-day reoperation. Standardized mean differences were used to assess covariate balance before and after applying propensity score matching (PSM) to compare outcomes between RS and BS cases. We subsequently used regression adjustments to control for any remaining imbalance and accurately assess the treatment effect.
RESULTS: A total of 16,034 complete encounters were included, of which 13,051 (81.4%) were RS and 2,983 (18.6%) were BS cases. Adjusted outcomes in the PSM analysis showed that RS cases were significantly less likely to have 30-day readmission. (OR = 0.72, 95% CI = 0.52 to 0.99), 30-day ICU visits (OR = 0.45, 95% CI = 0.19 to 0.93), and bleeding (OR= 0.48, 95% CI = 0.31 to 0.74) when compared to BS cases. Gastric leak, blood transfusion, and organ SSI were comparable between RS and BS cases. RS cases were associated with similar but longer OR times compared to BS cases.
CONCLUSIONS: When considering stapler type used in bariatric robotic procedures, patient outcomes differ between robotic SureForm stapler and BS, with RS cases having significantly reduced bleeding rates, 30-day readmission, and 30-day ICU visit.