OBJECTIVES: This study aims to report trends and evaluate outcomes and resource utilization (RU) by types of staplers in robotic gastric sleeve (RGS) procedures.

METHODS: Patients who underwent RGS procedures between 1/1/2018 and 12/31/2022 were extracted from PINC AI™ Healthcare Data. Inclusions were patients who used laparoscopic bedside stapler (BS) or robotic stapler (RS) and had non-zero costs. Outcomes (blood transfusion, bleeding, anastomotic leak, and ICU visit) and RU (total inpatient costs, operating room time (ORT), and length of stay (LOS)) were analyzed. We evaluated baseline balance in BS and RS and the bivariate association between covariates (patient and provider characteristics) and outcomes using the Chi-square/Fisher exact test and t-test/ANOVA. Multivariable general linear mixed models (GLMMs) with respective gamma or binomial distribution and log-link function were used to obtain adjusted outcomes variations between BS and RS. Sensitivity analysis was done by propensity scores covariate adjustment GLMMs.

RESULTS: Total 18892 discharged were included: 3740 (19.8%) BS and 15152(80.2%) RS cases. The number of RGS procedures increased from 1227 (2018) to 7005 (2022). The proportion of BS and RS was 88.6% and 11.4% in 2018 and 9.4% and 90.6% in 2022. 41.7% of patients who received RGS were aged <40, 49.1% non-Hispanic White, 53.9% with private insurance, and 40.5% resided in South region. The adjusted outcomes showed that RS group was significantly more likely to have blood transfusions (1.55(Odds ratio)±0.33(standard deviation (STD)), p<0.01) with similar bleeding and anastomotic leak rates and ICU stays, and increased ORT (21(mean)±1.3(STD) minutes, p<0.01) and costs ($3084±$115, p<0.01) compared to BS. RS patients (1.34 ± 0.007 days) had shorter LOS than BS patients (1.49±0.025 days). Sensitivity analysis showed similar results.

CONCLUSIONS: With significantly higher costs and less efficiency, robotic staplers have quickly been adopted in RGS. The cost and effectiveness of robotic staplers must be considered in the resource-constrained environment.