OBJECTIVES : To describe trends in comparative economic and clinical outcomes associated with use of powered vs. manual surgical staplers among patients undergoing major minimally-invasive surgical procedures.

METHODS : Retrospective studies of patients undergoing primary bariatric (Roux-en-Y gastric bypass/sleeve gastrectomy), right colorectal, or thoracic lobectomy procedures via minimally-invasive (laparoscopic/video-assisted/robotic) approaches between 1-1-2012 and 6-30-2017. Use of powered vs. manual staplers was identified from hospital administrative billing records. Patients with use of powered staplers were propensity score matched to those with use of manual staplers based on patient, procedure, and hospital/provider characteristics. Multivariable analyses accounting for hospital-level clustering were used to compare the following index admission outcomes between groups: hospital length of stay (LOS), total hospital costs, and hemostasis-related complications (bleeding/transfusion).

RESULTS : The total matched study cohort sizes were: bariatric (17,940), right colorectal (2,138), and thoracic lobectomy (906). Adjusted LOS was lower for powered vs. manual staplers in the analyses of thoracic lobectomy (4.6 vs. 5.9, P<0.001), and were similar between groups for bariatric (2.0 vs. 2.0, P=0.686), or right colorectal (4.8 vs. 4.7, P=0.918). Adjusted total hospital costs were lower for powered vs. manual staplers in the analyses of bariatric ($12,721 vs. $13,863, P=0.010) and thoracic lobectomy ($23,104 vs. $26,063, P=0.006), and did not differ between groups for right colorectal ($15,981 vs. $15,681, P=0.679). Adjusted rates of hemostasis complications were lower for powered vs. manual staplers in the analyses of bariatric (2.7% vs. 3.9%, P=0.012) and thoracic lobectomy (13.3% vs. 20.7%, P=0.002), and were similar between groups for right colorectal (13.9% vs. 12.9%, P=0.574).

CONCLUSIONS : This large real-world assessment across major minimally-invasive procedures suggested that the use of powered staplers, despite their potentially higher unit costs, was associated with similar or significantly more favorable economic and clinical outcomes as compared with the use of manual staplers – highlighting the importance of stapler choice.