PMD5 COMPARATIVE EFFECTIVENESS ASSESSMENT OF TWO POWERED SURGICAL STAPLING PLATFORMS IN LAPAROSCOPIC SLEEVE GASTRECTOMY

Abstract

To compare outcomes between the two latest innovations in powered stapling technology, the ECHELON FLEX™ GST system (GSTS) and the Signia™ system (SS), among patients undergoing laparoscopic sleeve gastrectomy (LSG) for obesity. Using the Premier Healthcare Database of US hospital discharge records, we selected patients undergoing inpatient LSG between 3/1/2017 (SS launch)-12/31/2018 (first=index admission). Outcomes measured during the index admission included intra/post-operative bleeding/transfusion (primary outcome), total hospital costs, length of stay (LOS), and operating room time (ORT); 30, 60, and 90-day all-cause inpatient readmissions were also examined. We used 1:1 cardinality matching to balance the GSTS and SS groups on numerous patient and provider/hospital characteristics, allowing a maximum standardized mean difference (SMD)≤0.05 for all matching covariates. Generalized estimating equations (GEE) accounting for hospital-level clustering were used to compare the study outcomes between the GSTS and SS groups. After matching, there were 491 patients in each group (982 total) and all covariates were well-balanced with all SMDs ≤0.05. The incidence proportion of bleeding/transfusion was significantly lower in the GSTS group as compared with the SS group (3 events/491 [0.61%] vs. 11 events/491 [2.24%], GEE-based odds ratio [GSTS=reference]=3.57, 95% CI=1.66-7.69, P=0.0012); this difference was driven primarily by diagnoses of acute post-hemorrhagic anemia: 2 of 3 events in GSTS and 8 of 11 events in SS. Differences between the GSTS and SS groups were statistically insignificant for mean hospital costs ($10,666 vs. $11,562, P=0.184), mean LOS (1.6 vs. 1.7 days, P=0.3624), mean ORT (113 vs. 117 minutes, P=0.1219), and all-cause inpatient readmission at 30 (2.2% vs. 2.1%, P=0.9764), 60 (3.2% vs. 2.9%, P=0.7632), and 90 (3.6% vs. 3.2%, P=0.7968) days. In this retrospective study of 982 patients undergoing LSG, GSTS was associated with a significantly lower rate of a composite bleeding/transfusion outcome as compared with SS, primarily driven by acute post-hemorrhagic anemia diagnoses.