Comparative Effectiveness of Powered Surgical Stapling in Patients Undergoing Minimally Invasive Thoracic Surgery
Author(s)
I-Wen E. Pan, BA, MPH, PhD, Zasim Azhar Siddiqui, MS, PhD, Jiejing Qiu, MS.
Medtronic, Boston, MA, USA.
Medtronic, Boston, MA, USA.
Presentation Documents
OBJECTIVES: To compare the effectiveness of two powered staplers used for patients who were treated with minimal-invasive thoracic surgery
METHODS: Patients older than 18 with a primary elective minimal-invasive (robotic-assisted or thoracoscopic) thoracic procedure, used either single-use (SU) or multiple-use (MU) powered stapling discharged between 2019 and 2023, were extracted from PINC AI™ Healthcare Data. Clinical outcomes (CO) and healthcare resource utilization (HRU) measured effectiveness. A propensity score matching (PSM) method with a caliper of 0.2 and 1:1 nearest neighbor matching for patients who used SU and MU was performed. We used patient and provider characteristics to calculate PS. The Chi-square or Fisher exact test and paired t-test were used to examine the CO/HRU variations in post-matched cases. We applied multivariable general-linear-model analysis for sensitivity analysis.
RESULTS: 4887 inpatient procedures were included, 63.7% SU and 36.3% MU cases. 1773 and 1362 were paired for two analysis groups: total minimal-invasive and thoracoscopic-only cohorts. After PSM, SU has higher rates of bleeding, air leak, and pneumothorax than MU in minimal-invasive (adjusted rates: SU, MU: 5.7%, 3.0%; 19.5%, 15.7%; 15.3%, 10.8%, all p-value <0.05) and thoracoscopic (5.9%, 2.9%; 18.7%, 14.2%; 16.1%, 9.4%, all p-value <0.001) cohorts. Also, SU has higher operating-room time (ORT) and length of stay (LOS) than MU in both minimal-invasive (mean differences: ORT 12 minutes (95% confidence interval: 6.6, 17.6), LOS: 0.7 days (0.5, 0.9) and thoracoscopic (ORT: 10 minutes (5, 17), LOS:0.6 days (0.4, 0.9)) cohorts. There is no difference in rates of conversion, infection, pneumonia, 30-day readmission, and intensive care unit visits between SU and MU. The total costs in 2023 USD of SU vs MU are equivalent. The sensitivity analyses presented similar results.
CONCLUSIONS: The study shows that multiple-use powered staplers are more effective than single-use powered staplers, with equivalent total inpatient costs and more efficient use of healthcare resources.
METHODS: Patients older than 18 with a primary elective minimal-invasive (robotic-assisted or thoracoscopic) thoracic procedure, used either single-use (SU) or multiple-use (MU) powered stapling discharged between 2019 and 2023, were extracted from PINC AI™ Healthcare Data. Clinical outcomes (CO) and healthcare resource utilization (HRU) measured effectiveness. A propensity score matching (PSM) method with a caliper of 0.2 and 1:1 nearest neighbor matching for patients who used SU and MU was performed. We used patient and provider characteristics to calculate PS. The Chi-square or Fisher exact test and paired t-test were used to examine the CO/HRU variations in post-matched cases. We applied multivariable general-linear-model analysis for sensitivity analysis.
RESULTS: 4887 inpatient procedures were included, 63.7% SU and 36.3% MU cases. 1773 and 1362 were paired for two analysis groups: total minimal-invasive and thoracoscopic-only cohorts. After PSM, SU has higher rates of bleeding, air leak, and pneumothorax than MU in minimal-invasive (adjusted rates: SU, MU: 5.7%, 3.0%; 19.5%, 15.7%; 15.3%, 10.8%, all p-value <0.05) and thoracoscopic (5.9%, 2.9%; 18.7%, 14.2%; 16.1%, 9.4%, all p-value <0.001) cohorts. Also, SU has higher operating-room time (ORT) and length of stay (LOS) than MU in both minimal-invasive (mean differences: ORT 12 minutes (95% confidence interval: 6.6, 17.6), LOS: 0.7 days (0.5, 0.9) and thoracoscopic (ORT: 10 minutes (5, 17), LOS:0.6 days (0.4, 0.9)) cohorts. There is no difference in rates of conversion, infection, pneumonia, 30-day readmission, and intensive care unit visits between SU and MU. The total costs in 2023 USD of SU vs MU are equivalent. The sensitivity analyses presented similar results.
CONCLUSIONS: The study shows that multiple-use powered staplers are more effective than single-use powered staplers, with equivalent total inpatient costs and more efficient use of healthcare resources.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
MT37
Topic
Medical Technologies
Disease
SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), STA: Surgery