OBJECTIVES: Surgeons often use buttress material to reinforce staple lines as a preventive measure against potential leaks and bleeding. It is unknown whether powered endoscopic stapling technology performs differentially from manual technology when used in conjunction with buttress. In this post-hoc sub-analysis of a previously-published study, we compared clinical and economic outcomes of powered vs. manual endoscopic staplers when used in conjunction with buttress in bariatric surgery.

METHODS: Using the Premier Healthcare Database of US hospital discharge records, we selected patients who underwent a primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy (between 1/1/2012-9/30/2015) with concomitant use of buttress and powered or manual endoscopic surgical staplers. Outcomes were: bleeding/transfusion; operating room (OR) time; hospital length of stay (LOS); total hospital, medical/surgical supply, room and board, and OR costs; discharge status; and 30/60/90-day all-cause readmissions. We used generalized estimating equations accounting for hospital-level clustering and adjusting for patient/provider/hospital characteristics to compare outcomes between powered and manual stapler groups; sub-analyses compared the powered staplers (all of which were Ethicon) to manual staplers by brand (Ethicon/Medtronic).

RESULTS: Study included: 2,259 patients with powered staplers (all Ethicon) and buttress, 3,195 patients with manual staplers and buttress (1,925 Ethicon, 1,324 Medtronic; 54 had both). Powered staplers were associated with 17.0% lower adjusted room and board cost compared with manual staplers ($1,755 vs. $2,114, p=0.005); differences in all other economic and clinical outcomes were not statistically significant. Within sub-analyses, powered staplers were associated with: 14.5% lower adjusted room and board costs compared with Ethicon manual ($1,734 vs. $2,028, p=0.009); 30.4% lower adjusted supply cost ($4,480 vs. $6,437, p=0.001) and 20.1% lower adjusted total hospital cost ($11,856 vs. $14,832, p=0.009) compared with Medtronic manual.

CONCLUSIONS: In this post-hoc sub-analysis, use of powered staplers with buttress was associated with cost saving compared with manual staplers with buttress.