SMARTFIRE STAPLER USAGE CHARACTERISTICS MAY SIGNAL CASE COMPLEXITY AND INFORM POST-OPERATIVE RESOURCE UTILIZATION IN ROBOTIC LOW ANTERIOR RESECTION
Author(s)
Kay Hung, MD1, Shih Hao Lee, MA2, Feibi Zheng, MD, MBA2;
1Stanford University, Stanford, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA
1Stanford University, Stanford, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA
OBJECTIVES: Complications of low anterior resections (LAR), including anastomotic leak and bleeding, can be affected by staple line formation. Narrow pelvic spaces can necessitate overlapping staple lines and extreme stapler angulation. SmartFire technology in SureForm staplers captures data related to these factors. We aimed to investigate whether such stapler usage parameters are associated with differences in clinical outcomes and hospital resource utilization.
METHODS: Using an internal database of stapler performance parameters linked to clinical outcomes and hospital resource utilization data, 1,664 robotic LAR (total 5,016 SureForm stapler fires) from January 1, 2019 to June 30, 2024 were examined. Extreme angulation was defined as the greatest absolute angle encountered in 20% of all stapler fires. Multivariate logistic regression models adjusted for patient demographics, comorbidities, hospital volume in robotic colorectal procedures, and surgeon volume in robotic LAR were used.
RESULTS: The average number of pauses per staple fire was 1.1. Average number of staple loads fired at an extreme angle per case was 0.35. Average number of staple fires per case was 3. A greater number of pauses was associated with higher likelihood of ileus (OR 1.10 (1.04-1.17); p<0.001), 30-day readmission (OR 1.10 (1.04-1.16); p=0.001), greater length of stay (LOS) (OR 1.03 (1.03-1.04); p<0.001) and ICU LOS (OR 1.05 (1.02-1.08); p<0.001). A greater number of fires at extreme angulation was associated with higher likelihood of bleeding (OR 1.31 (1.05-1.62); p=0.01), surgical site infection (OR 1.49 (1.06-2.01); p=0.01), greater LOS (OR 1.04 (1.01-1.07); p=0.01) and ICU LOS (OR 1.32 (1.21-1.45); p<0.001). A greater number of staple fires was associated with higher likelihood of ileus (OR 1.08 (1.07-1.30); p<0.001), 30-day readmission (OR 1.22 (1.11-1.33); p<0.001), greater LOS (OR 1.04 (1.03-1.05); p<0.001) and ICU LOS (OR 1.05 (1.00-1.10); p=0.04).
CONCLUSIONS: Stapler usage characteristics may be indicators of case complexity associated with differences in hospital resource utilization.
METHODS: Using an internal database of stapler performance parameters linked to clinical outcomes and hospital resource utilization data, 1,664 robotic LAR (total 5,016 SureForm stapler fires) from January 1, 2019 to June 30, 2024 were examined. Extreme angulation was defined as the greatest absolute angle encountered in 20% of all stapler fires. Multivariate logistic regression models adjusted for patient demographics, comorbidities, hospital volume in robotic colorectal procedures, and surgeon volume in robotic LAR were used.
RESULTS: The average number of pauses per staple fire was 1.1. Average number of staple loads fired at an extreme angle per case was 0.35. Average number of staple fires per case was 3. A greater number of pauses was associated with higher likelihood of ileus (OR 1.10 (1.04-1.17); p<0.001), 30-day readmission (OR 1.10 (1.04-1.16); p=0.001), greater length of stay (LOS) (OR 1.03 (1.03-1.04); p<0.001) and ICU LOS (OR 1.05 (1.02-1.08); p<0.001). A greater number of fires at extreme angulation was associated with higher likelihood of bleeding (OR 1.31 (1.05-1.62); p=0.01), surgical site infection (OR 1.49 (1.06-2.01); p=0.01), greater LOS (OR 1.04 (1.01-1.07); p=0.01) and ICU LOS (OR 1.32 (1.21-1.45); p<0.001). A greater number of staple fires was associated with higher likelihood of ileus (OR 1.08 (1.07-1.30); p<0.001), 30-day readmission (OR 1.22 (1.11-1.33); p<0.001), greater LOS (OR 1.04 (1.03-1.05); p<0.001) and ICU LOS (OR 1.05 (1.00-1.10); p=0.04).
CONCLUSIONS: Stapler usage characteristics may be indicators of case complexity associated with differences in hospital resource utilization.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO172
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Gastrointestinal Disorders