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Powered vs manual staplers

Powered staplers associated with benefits vs manual staplers

One of the largest retrospective studies of surgical stapling reports fewer bleeding complications, shorter OR time, and reduced hospital costs in bariatric procedures

Powered surgical staplers result in significant clinical and economic benefits, compared to the most manual staplers, according to a study by researchers from Johnson & Johnson. The study showed that use of powered staplers was associated with significant clinical and economic benefits including 47% lower rate of bleeding complications, 14% shorter operating room time and 13% lower overall hospital costs compared to manual staplers.

The real-world study, ‘Comparison of Economic and Clinical Outcomes between Patients Undergoing Laparoscopic Bariatric Surgery with Powered vs. Manual Endoscopic Surgical Staplers’, published in The Journal of Medical Economics, is a retrospective analysis of hospital discharge data from the Premier Perspective Hospital Database consisting of approximately 700 hospitals and over 21,000 patients who underwent laparoscopic bariatric surgery between 2012 and 2015.

The study compared the economic and clinical outcomes between patients undergoing laparoscopic Roux-en-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers.

Patients (aged ≥21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012–September 30, 2015) were included in the study and the use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions.

Outcomes

The study reported that powered and manual stapler groups comprised 9,851 patients (mean age = 44.6 years; 79.3% female) and 21,558 patients (mean age = 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p=0.981). Adjusted mean total hospital costs ($12,415 vs $13,547, p=0.003), adjusted mean supply costs ($4,629 vs $5,217, p=0.011), and adjusted mean operating room costs ($4,126 vs $4,413, p=0.009) were significantly lower in the powered vs manual stapler group. Powered staplers were associated with a US$35 million reduction to the healthcare burden for the procedures conducted in this study.

The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p=0.025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p>0.05). Sub-analysis by manufacturer showed similar results.

Surgical stapling devices are widely used for transection and anastomosis in both open and laparoscopic surgical oncology and bariatric procedures. Surgeons often choose between manual and powered stapling devices based on their training, professional experience, and perceived cost benefits. This study, the first to compare economic and clinical outcomes linked to the type of stapler used, can help inform this decision.

“In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting,” the authors concluded, although they acknowledged that this observational study cannot establish causal linkages.

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