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Lie JJ, Samarasinghe N, Karimuddin AA, Brown CJ, Phang PT, Raval MJ, Ghuman A. Anastomotic leak rate following the implementation of a powered circular stapler in elective colorectal surgeries: a retrospective cohort study. Surg Endosc 2024:10.1007/s00464-024-11082-5. [PMID: 39060622 DOI: 10.1007/s00464-024-11082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/13/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The objective of this study was to compare the anastomotic leak rates between powered and manual circular staplers in elective left-sided colorectal resections. METHODS A retrospective cohort study of elective left-sided colorectal resections before and after implementation of a powered circular stapler at a tertiary care center was conducted. The manual stapler group consisted of consecutive resections performed between January 2016 to December 2016 and the powered stapler group, between September 2021 and December 2022. Primary outcome was 30-day anastomotic leak rate. A chi-squared analysis was performed to compare anastomotic leak rates. Factors associated with anastomotic leak were examined. RESULTS Two-hundred forty-seven patients were included: 154 in the manual stapler group and 93 in the powered stapler group. Mean (SD) age was 60 (15) years old, 37.7% were female and 72.9% of resections were performed for malignancy. Both groups had similar patient characteristics and surgical technique. Overall leak rate was 2.0% in the manual stapler group and 10.8% in the powered stapler group. The powered staplers were found to have 6.06 times the odds of leak compared to manual staplers (95% CI, 1.62-22.65; p = 0.01). None of the other factors were found to be associated with anastomotic leak. CONCLUSIONS Patients who had left-sided colorectal anastomosis had higher anastomotic leak rates with powered compared to manual circular staplers. This finding is contrary to previous retrospective studies that found lower leak rates with powered staplers.
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Affiliation(s)
- Jessica J Lie
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Ahmer A Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Carl J Brown
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - P Terry Phang
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Manoj J Raval
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Amandeep Ghuman
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
- Division of General Surgery, St Paul's Hospital, Vancouver, BC, Canada.
- Department of Surgery, University of British Columbia, Colorectal Surgeon, St. Paul's Hospital, 1081 Burrard St, Rm C310, Vancouver, BC, V6Z 1Y6, USA.
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Pla-Martí V, Martín-Arévalo J, Moro-Valdezate D, García-Botello S, Pérez-Santiago L, Barrachina-Martinez I, González-de-Julián S, Vivas-Consuelo D, Espí-Macías A. Incidence of anastomotic leakage using powered circular staplers versus manual circular staplers for left colorectal anastomosis: a cost-effectiveness analysis. Tech Coloproctol 2024; 28:76. [PMID: 38954099 PMCID: PMC11219427 DOI: 10.1007/s10151-024-02936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/15/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Colorectal anastomotic leakage causes severe consequences for patients and healthcare system as it will lead to increased consumption of hospital resources and costs. Technological improvements in anastomotic devices could reduce the incidence of leakage and its economic impact. The aim of the present study was to assess if the use of a new powered circular stapler is cost-effective. METHOD This observational study included patients undergoing left-sided circular stapled colorectal anastomosis between January 2018 and December 2021. Propensity score matching was carried out to create two comparable groups depending on whether the anastomosis was performed using a manual or powered circular device. The rate of anastomotic leakage, its severity, the consumption of hospital resources, and its cost were the main outcome measures. A cost-effectiveness analysis comparing the powered circular stapler versus manual circular staplers was performed. RESULTS A total of 330 patients were included in the study, 165 in each group. Anastomotic leakage rates were significantly different (p = 0.012): 22 patients (13.3%) in the manual group versus 8 patients (4.8%) in the powered group. The effectiveness of the powered stapler and manual stapler was 98.27% and 93.69%, respectively. The average cost per patient in the powered group was €6238.38, compared with €9700.12 in the manual group. The incremental cost-effectiveness ratio was - €74,915.28 per patient without anastomotic complications. CONCLUSION The incremental cost of powered circular stapler compared with manual devices was offset by the savings from lowered incidence and cost of management of anastomotic leaks.
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Affiliation(s)
- V Pla-Martí
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain.
- Department of Surgery, University of Valencia, Valencia, Spain.
| | - J Martín-Arévalo
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - D Moro-Valdezate
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - S García-Botello
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
| | - L Pérez-Santiago
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - I Barrachina-Martinez
- Research Unit for Health Economics and Management, Universitat Politècnica de València, Camino de Vera S/N, 46022, Valencia, Spain
| | - S González-de-Julián
- Research Unit for Health Economics and Management, Universitat Politècnica de València, Camino de Vera S/N, 46022, Valencia, Spain
| | - D Vivas-Consuelo
- Research Unit for Health Economics and Management, Universitat Politècnica de València, Camino de Vera S/N, 46022, Valencia, Spain
| | - A Espí-Macías
- Department of General and Digestive Surgery, Biomedical Research Institute INCLIVA, University Clinic Hospital of Valencia, Av. Blasco Ibáñez, 17, 46010, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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Matsuhashi N, Tajima JY, Yokoi R, Kiyama S, Endo M, Sato Y, Kuno M, Hayashi H, Asai R, Fukada M, Yasufuku I, Tanaka Y, Okumura N, Murase K, Ishihara T, Takahashi T. Short-term outcomes associated with the use of a new powered circular stapler for rectal reconstructions: a retrospective study comparing it to manual circular staplers using inverse probability of treatment weight analysis. BMC Surg 2023; 23:332. [PMID: 37898761 PMCID: PMC10613387 DOI: 10.1186/s12893-023-02218-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/04/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The most common postoperative complication in malignant rectal surgery is anastomotic leakage (AL). AL after anterior or low anterior resection in rectal tumors is a fatal postoperative complication. Recently, the first automated suture circular stapler, which is expected to reduce the incidence of AL, (J&J). MATERIALS AND METHODS: This study included a total of 248 rectal tumor patients who underwent double stapler technique (DST) anastomotic procedures in the department of gastroenterological surgery /pediatric surgery at Gifu University School of Medicine from January 2017 to December 2021. The experience of a single institution utilizing the The Echelon circular™ stapler (ECP stapler:Manual VS Automatic) in rectal surgery cases was evaluated retrospectively from maintained database. RESULT One hundred thirty-nine patients (58.4%) were performed by manual circular stapling, 99 patients (41.6%) by powerd circular stapling. Diverting stoma was performed in 45 cases (32.4%) by manual circular stapling, 42 patients (42.4%) by powerd circular stapling Postoperative complications were occurred clavien-dindo grade II or higher in 57 cases (23.9%) and grade III or higher in 20 cases (8.4%). Anastomotic leakage occurred in 14 patients (5.9%) within all grades. After IPTW, the variables of patient characteristics was SMD ≤ 0.2 (Table.3), and there was a significant difference in anastomotic leakage (Odds Ratio (OR), 0.57; 95% Confidence Interval(CI), 0.34-0.98; p = 0.041). In addition, there was no significant difference in postoperative complications in grade II or higher (OR, 0.88; 95%CI, 0.65-1.19; p = 0.417) and grade III or higher (OR, 0.46; 95%CI, 0.29-0.74; p = 0.001) were significantly remarkable lower in powered circular stapling group. CONCLUSION In this IPTW comparison of patients undergoing rectal reconstructions, the ECP trial cohort had lower risks of several surgical complications AL and statistically signifcant lower rates of ileus/bowel obstruction, infection, and bleeding as Clavien-Dindo ≥ grade II and III as compared with for whom manual circular staplers were used.
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Affiliation(s)
- Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan.
| | - Jesse Yu Tajima
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Ryoma Yokoi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masahide Endo
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masashi Kuno
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Hirokatsu Hayashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Ryuichi Asai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, 501-1194, Japan
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Mukai T, Maki A, Shimizu H, Kim H. The economic burdens of anastomotic leakage for patients undergoing colorectal surgery in Japan. Asian J Surg 2023; 46:4323-4329. [PMID: 37423861 DOI: 10.1016/j.asjsur.2023.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 04/07/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Akihiro Maki
- Johnson & Johnson K.K. Medical Company, 3-5-2 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Hideharu Shimizu
- Johnson & Johnson K.K. Medical Company, 3-5-2 Nishikanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Hyesung Kim
- Johnson and Johnson Medical, 92 Hangang-daero, Yongsan-gu, Seoul, 04386, South Korea
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Gutierrez M, Jamous N, Petraiuolo W, Roy S. Global Surgeon Opinion on the Impact of Surgical Access When Using Endocutters Across Specialties. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:62-71. [PMID: 37744691 PMCID: PMC10515882 DOI: 10.36469/001c.87644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
Background: Despite design enhancements in endocutters, key challenges related to limited surgical access and space can impact stapling and, potentially, surgical outcomes. Objectives: This study aimed to develop consensus statements outlining the clinical value of precise articulation and greater anatomical access in minimally invasive surgery performed by bariatric, colorectal, and thoracic surgeons. Methods: Colorectal, bariatric, and thoracic surgeons from Japan, the United States, United Kingdom, and France participated in a 2-round modified Delphi panel. Round 1 included binary, Likert scale-type, multiple-response, and open-ended questions. These were converted to affirmative statements for round 2 if sufficient agreement was reached. Consensus was set at a predefined threshold of at least 90% of panelists across all surgical specialties and regions selecting the same option ("agree" or "disagree") for the affirmative statements. Results: Of the 49 statements in the round 2 questionnaire, panelists (n=135) reached consensus that (1) tissue slippage outside stapler jaws can occur due to limited access and space; (2) greater jaw aperture could help to manipulate thick or fragile tissue more easily; (3) articulation of an endocutter is clinically important in laparoscopic surgeries; (4) improved access to hard-to-reach targets and in limited space would improve safety; and (5) an endocutter with improved access through greater articulation would become common use. Discussion: By understanding user-specific challenges and needs from both specialty- and region-wide perspectives, endoscopic stapling devices can continue to be refined. In this study, improved articulation and greater jaw aperture were the key design features examined. Improved articulation and greater jaw aperture were key stapler design features identified in this study that may mitigate the risk of instrument clashes and intraoperative complications such as anastomotic leaks. Conclusions: This study gained insights into surgeons' perspective across a variety of specialties and from 3 distinct geographies. Participating surgeons reached consensus that an endocutter with greater jaw aperture and articulation may improve surgical access and has potential to improve surgical outcomes.
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Affiliation(s)
| | - Nadine Jamous
- Johnson & Johnson MedTech, New Brunswick, New Jersey, USA
| | | | - Sanjoy Roy
- Johnson & Johnson MedTech, New Brunswick, New Jersey, USA
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7
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A Call to Action for Ergonomic Surgical Devices Designed for Diverse Surgeon End Users. Obstet Gynecol 2023; 141:463-466. [PMID: 36735398 DOI: 10.1097/aog.0000000000005068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
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8
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Wong JMK, Moore KJ, Lewis P, Reid M, Saul K, Carey ET. Ergonomic Assessment of Surgeon Characteristics and Laparoscopic Device Strain in Gynecologic Surgery. J Minim Invasive Gynecol 2022; 29:1357-1363. [PMID: 36191883 DOI: 10.1016/j.jmig.2022.09.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To evaluate whether surgeon characteristics, including sex and hand size, were associated with grip strength decline with laparoscopic advanced energy devices. DESIGN Prospective cohort study. SETTING Ergonomic simulation at an academic tertiary care site and the Society of Gynecologic Surgeons 47th Annual Meeting. PATIENTS Thirty-eight participants (19 women and 19 men) were recruited. INTERVENTIONS Surgeon anthropometric measurements were collected. Each participant completed a 120-second trial of maximum voluntary effort with 3 laparoscopic advanced energy devices (LigaSure, HALO PKS, and ENSEAL). Grip strength was measured using a handheld dynamometer. Subjects completed the NASA Raw Task Load Index scale after each device trial. Grip strengths and ergonomic workload scores were compared using Student t tests and Wilcoxon rank sum tests where appropriate. Univariate and multivariate models analyzed hand size and ergonomic workload. MEASUREMENTS AND MAIN RESULTS Women had lower baseline grip strength (288 vs 451 N) than men, as did participants with glove size <7 compared with ≥7 (231 vs 397 N). Normalized grip strength was not associated with surgeon sex (p = .08), whereas it was significantly associated with surgeon glove size (p <.01). Grip strength decline was significantly greater for smaller compared to larger handed surgeons for LigaSure (p = .02) and HALO PKS devices (p <.01). The ergonomic workload of device use was significantly greater for smaller compared to larger handed surgeons (p <.01). Surgeon handspan significantly predicted grip strength decline with device use, even after accounting for potential confounders (R2 = .23, β = .8, p <.01). CONCLUSION Surgeons with smaller hand size experienced a greater grip strength decline and greater ergonomic workload during repetitive laparoscopic device use. No relationship was found between surgeon sex and grip strength decline or ergonomic workload. Laparoscopic device type was also identified as a significant main effect contributing to grip strength decline. These findings point toward ergonomic strain stemming from an improper fit between the laparoscopic device and the surgeon's hand during device use.
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Affiliation(s)
- Jacqueline M K Wong
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (Dr. Wong).
| | - Kristin J Moore
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (Drs. Moore and Carey)
| | - Preston Lewis
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh (Mr. Lewis, Ms. Reid, and Dr. Saul), North Carolina
| | - Monique Reid
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh (Mr. Lewis, Ms. Reid, and Dr. Saul), North Carolina
| | - Katherine Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh (Mr. Lewis, Ms. Reid, and Dr. Saul), North Carolina
| | - Erin T Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill (Drs. Moore and Carey)
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9
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Vanstraelen S, Coosemans W, Depypere L, Mandeville Y, Moons J, Van Veer H, Nafteux P. Real-life introduction of powered circular stapler for esophagogastric anastomosis: cohort and propensity matched score study. Dis Esophagus 2022; 36:6758201. [PMID: 36222069 PMCID: PMC10150171 DOI: 10.1093/dote/doac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/12/2022] [Indexed: 12/11/2022]
Abstract
Anastomotic leakage after esophagectomy is one of the most feared complications, which results in increased morbidity and mortality. Our aim was to evaluate the impact of a powered circular stapler on complications after esophagectomy with intrathoracic anastomosis for esophageal cancer. Between May 2019 and July 2021, all consecutive oesophagectomies for cancer with intrathoracic anastomosis in a high-volume center were included in this retrospective study. Surgeons were free to choose either a manual or a powered circular stapler. Preoperative characteristics and postoperative complications were recorded in a prospective database, according to EsoData. Propensity score matching (age, body mass index, Eastern cooperative oncology group (ECOG) performance and neoadjuvant therapy) was conducted to reduce potential confounding. We included 128 patients. Powered and manual circular staplers were used in 62 and 66 patients, respectively. Fewer anastomotic leakages were observed with the powered stapler group (OR = 7.3 (95%CI: 1.58-33.7); [3.2% (n = 2) vs 19.7% (n = 13), respectively; p = 0.004]). After propensity score matching, this remained statistically significant (OR = 8.5 (95%CI: 1.80-40.1); [4.1% (n = 2) vs 20.4% (n = 10), respectively; p = 0.013]). Additionally, anastomotic diameter was significantly higher with the powered stapler (median: 29 mm (63.3%) vs 25 mm (57.1%), respectively; p < 0.0001). There was no significant difference in comprehensive complication index (p = 0.146). A decreased mean length of stay was observed in the powered stapler group (11.1 vs 18.7 days respectively; p = 0.022). Postoperative anastomotic leakage after esophageal resection was significantly reduced after the introduction of the powered circular stapler, consequently resulting in a reduced length of stay. Further evaluation on long-term strictures and quality of life are warranted to support these results.
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Affiliation(s)
- Stijn Vanstraelen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Yannick Mandeville
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Disease, Metabolism, and Aging, KU Leuven, Leuven, Belgium
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10
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Bai J, Zhao Y, Liang H, Li J, Zhang C. Indirect comparison between powered and manual circular staplers for left-sided colorectal anastomoses: clinical and economic outcomes in China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:45. [PMID: 36045434 PMCID: PMC9434853 DOI: 10.1186/s12962-022-00380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aims This study aimed to examine the economic and clinical benefits of a new powered circular stapler for left-sided colorectal construction in China. Methods A decision analysis model was constructed for a cohort of adult patients who underwent left-sided colorectal anastomoses, using either the Echelon Circular Powered (ECP) stapler) or the conventional manual circular staplers (MCS). The complications rates and healthcare resource utilization in the ECP cohort were obtained from the single-arm ECP trial (NCT03326895). For the MCS cohort, retrospective data from 20 Chinese hospitals were analyzed. Listing prices were used to estimate the costs of the staplers in China. Propensity score matching (PSM) was employed to adjust for the imbalance between the two cohorts. Anastomotic leak rate, length of stay (LOS), 90-day readmission rate, and direct medical costs were used for the decision analysis model parameters. A budget impact analysis was conducted to compare the total hospitalization expenditure between ECP and manual circular staplers from the hospital’s perspective in China. Results Assuming 100 procedures per year, the anastomotic leak rate was 1.79 and 29.76 per 100 procedures in the ECP and MCS cohorts, respectively. LOS was 1,426.91 days in the ECP cohort, compared to 1,702.38 days in the MCS cohort. The 90-day readmission rate was also lower in the ECP cohort than the MCS cohort (19.10 vs. 26.19 per 100 procedures). For the 100 procedures, the annual total hospitalization costs for left-sided colorectal anastomosis were reduced from ¥7,152,251 using manual circular staplers to ¥6,919,306 using ECP. Despite a higher acquisition cost of ECP compared to the manual staplers (¥711,200 vs. ¥441,700), an annual saving of ¥232,945in the total cost resulted from lower rates of complications and shorter LOS. Sensitivity analyses presented consistent savings using ECP, and the ECP cost and cost of the index hospitalization with anastomotic leak were found the most influencing factors. Conclusions There were clinical and economic benefits of ECP, compared to manual circular staplers for left-sided colorectal anastomoses. Further direct comparative studies on the use of ECP in practice in Chinese hospital settings are warranted.
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Affiliation(s)
- Junwei Bai
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Yingnan Zhao
- Division of Clinical and Administrative Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Hong Liang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Junmeng Li
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China.
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