Impact of Stapler Platforms on Outcomes in Thoracoscopic Pulmonary Resections
Thomas Fabian, Albany Medical College, Albany, NY
OBJECTIVE: Surgical stapling during pulmonary resection has become routine. We sought to evaluate the impact of graduated compression (GC) technology compared to constant compression (CC) technology on patients undergoing video assisted Thoracoscopic (VATS) pulmonary resection.
METHODS: Premier Perspective Database (PPD) was used to identify all inpatient discharges with primary procedure code for VATS between January 2012 and June 2013 at participating institutions in North America. Patients undergoing any pulmonary resection utilizing staplers were eligible for inclusion with the exception of pneumonectomy. Patients were separated into the GC and CC groups and compared retrospectively. Primary endpoints included air leak, LOS, and hospitalization costs.
RESULTS: During the study period 2722 patients underwent VATS pulmonary resection. Of those, 559 were performed using the GC technology and 2163 using CC technology. Patients in the GC group were less likely to have their surgery performed at a teaching hospital (42% vs. 51, p=0.0002). In multivariate analysis patients undergoing surgery utilizing the GC technology were 30% less likely to have an air leak (OR=0.70, 95% CI 0.52, 0.95), p=0.02) compared to patients using CC technology. Median LOS was 9.03 days in the GC group vs. 9.44 days in CC group, (p=0.48). Total hospitalization cost were less (26349 vs 27735 US dollars, p=0.41) respectively.
CONCLUSIONS: The GC technology is associated with fewer air leaks in comparison to more traditional stapler technology. Although more expensive surgical costs were seen in the GC group an overall hospitalization cost were reduced in comparison.