Clinical and economic benefits associated with the use of powered and tissue-specific endoscopic staplers among the patients undergoing thoracoscopic lobectomy for lung cancer

Figures & data

Figure 1. Comparison of conventional staplers and tissue-specific staplers. (A) Gripping surface technology (GST) system cartridge. The gripping surface technology utilizes proprietary pocket extensions to stabilize tissue and hold it in place, as well as support and guide staple legs toward anvil pockets during firing. (B) Re-designed bent staple tips with asymmetrical legs in GST staplers. (C) Powered vascular staplers (PVS) system with narrow anvil and curved tip.

Table 1. Patient demographics and clinical characteristics.

	Group 1 (n = 117)	Group 2 (n = 158)	p-value
Gender, n (%)			0.1400^a
Male	69 (59.0%)	79 (50.0%)
Female	48 (41.0%)	79 (50.0%)
Age, mean (SD)	61.8 ± 10.5	63.7 ± 9.9	0.1424^b
BMI (kg/m^2), mean (SD)	23.6 ± 3.1	23.9 ± 2.9	0.4607^c
Smoking History, n (%)			0.0099^a
Never	72 (61.5%)	117 (74.1%)
Former	22 (18.8%)	29 (18.4%)
Current	23 (19.7%)	12 (7.6%)
Smoking Pack-Years, mean (SD)	39.2 ± 22.5	32.9 ± 22.1	0.2477^b
Comorbidities
Hypertension	44 (37.6%)	66 (41.8%)	0.4857^a
Diabetes	17 (14.5%)	27 (17.1%)	0.5672^a
Liver cirrhosis	3 (2.6%)	9 (5.7%)	0.2087^a
Pulmonary disease*	2 (1.7%)	5 (3.2%)	0.7025^d
Cardiovascular disease	12 (10.3%)	10 (6.3%)	0.2353^a
Chronic kidney disease	2 (1.7%)	1 (0.6%)	0.5767^d
Cerebrovascular disease	1 (0.9%)	8 (5.1%)	0.0832^d
Pulmonary function, mean (SD)
FEV1 (L)	2.4 ± 0.6	2.6 ± 0.8	0.0722^b
DLCO (%)	100.9 ± 21.5	96.2 ± 17.6	0.0175^b
Tumor location			0.0615^a
RUL	33 (28.2%)	52 (32.9%)
RML	8 (6.8%)	13 (8.2%)
RLL	37 (31.6%)	26 (16.5%)
LUL	19 (16.2%)	30 (19.0%)
LLL	20 (17.1%)	37 (23.4%)
Tumor histology			0.0686^a
Adeno ca	87 (74.4%)	135 (85.4%)
Squamous cell ca	20 (17.1%)	16 (10.1%)
Others**	10 (8.5%)	7 (4.4%)
TNM AJCC stage (pTNM)			0.7972^a
I	87 (74.4%)	123 (77.8%)
II	18 (15.4%)	21 (13.3%)
III	12 (10.3%)	14 (8.9%)

Abbreviations. SD, Standard Deviation.

* Pulmonary disease—COPD, ILD.

**Others—Large cell ca, NSCLC, not specified, Small cell ca, other.

^a Chi-square test.

^bWilcoxon rank-sum test.

^cIndependent t-test.

^dFisher’s exact test.

Table 2. Comparison of operative outcomes between two groups.

	Group 1 (n = 117)	Group 2 (n = 158)	p-value	% difference
Operation time (mi)	189.9 ± 77.5	137.1 ± 49.9	<0.0001^a	−27.8
Pleural adhesion	34 (29.1%)	7 (4.4%)	<0.0001^b	−84.8
Thoracotomy conversion	1 (0.9%)	0 (0.0%)	0.4255^a	−100.0
Intraoperative event
Yes	3 (2.6%)	1 (0.6%)	0.3153^c	2.0
Significant hypotension	1 (0.9%)	0 (0.0)
Arrhythmia	1 (0.9%)	1 (0.6%)
Desaturation	0 (0.0%)	0 (0.0%)
Other	1 (0.9%)	0 (0.0%)
No	114 (97.4%)	157 (99.4%)
Hemostasis
Intraoperative blood loss (mL)	182.4 ± 328.7	79.8 ± 110.0	0.0004^a	−56.3
Transfusion	1 (0.9%)	0 (0.0%)	0.4255^c	−100.0
Hemostasis material usage, (per case)	1.34 ± 0.7	0.91 ± 0.9	<0.0001^a	−32.1
Surgicel fibrillar	15 (8.7%)	66 (31.4%)
Tachocomb	23 (13.4%)	50 (23.8%)
Tisseel	36 (20.9%)	5 (2.4%)
Beriplat-P	27 (15.7%)	0 (0.0%)
None	71 (41.3%)	89 (42.4%)
Number of cartridges	6.2 (3.0)	5.2 (1.8)	0.0170^a	−16.2
Complications
Prolonged air leakage (≥ 7 days)	46 (39.3%)	46 (29.1%)	0.0763^b	−25.9
Surgical site infection	0 (0.0%)	1 (0.6%)	1.000^c	–
Pneumonia	5 (4.2%)	7 (4.4%)	1.000^b	3.7
Empyema	2 (1.7%)	1 (0.6%)	0.5770^c	−63.0
Acute respiratory distress syndrome	1 (0.9%)	2 (1.3%)	1.000^c	48.1
Chylothorax	1 (0.9%)	2 (1.3%)	1.000^c	48.1
Pleural effusion	5 (4.3%)	5 (3.2%)	0.7481^c	−25.9
Bleeding	0 (0.0%)	1 (0.6%)	1.000^c	–
Pleurodesis	21 (18.0%)	6 (3.8%)	<0.0001^b	−78.8
Length of chest tube stay	6.5 ± 4.2	6.3 ± 3.4	0.5042^a	−3.8
Length of stay	7.5 ± 4.9	6.9 ± 5.0	0.0535^a	−8.2
30 days surgical related readmission	8 (6.8%)	5 (3.2%)	0.1559^b	−53.7
Length of stay due to readmission	3.9 ± 5.5	6.4 ± 5.3	0.2327^a	65.2

^a Wilcoxon rank-sum test.

^bChi-square test.

^cFisher’s exact test.

Table 3. Comparison of economic outcomes between two groups.

	Group 1 (n = 117)	Group 2 (n = 158)	p-value	% difference
Cost for hemostatic materials
Total Cost (KRW)	181,234 ± 100,876 ($152.37 ± 84.80$)	174,579 ± 190,103 ($146.75 ± 159.80)	0.0499^a	−3.7
Adjusted Total (KRW)	198,996 ± 110,253 ($167.28 ± 92.68)	175,291 ± 191,003 ($147.35 ± 160.56)	0.0101^a	−11.9
Cartridge cost
Crude (KRW)	1,006,707 ± 449,562 ($846.26 ± 192.96)	836,473 ± 306,056 ($703.10 ± 257.25)	0.0004	−16.9
Adjusted total (KRW)	1,105,091 ± 489,838 ($928.88 ± 411.70)	839,011 ± 307,894 ($705.17 ± 258.78)	<0.0001	−24.1
Hospital cost
Total (KRW)	13,293,691 ± 3,965,976 ($11,173.05 ± 3,333.31)	12,838,579 ± 4,982,470 ($10,792.35 ± 4,188.36)	0.0344	−3.4
Adjusted total (KRW)	14,610,162 ± 4,386,628 ($12,281.58 ± 3,687.17)	12,876,111 ± 5,010,878 ($10,822.99 ± 4,211.88)	<0.0001	−11.9
Cost for 30 days readmission
Total cost (KRW)	1,324,039 ± 2,179,276 ($1,112.92 ± 1,831.79)	2,141,610 ± 2,184,647 ($1,800.13 ± 1,836.30)	0.2134	61.7
Adjusted total cost (KRW)	1,464,307 ± 2,397,051 ($1,230.82 ± 2,014.84)	2,148,069 ± 2,185,135 ($1,805.56 ± 1,836.87)	0.3413	46.7

^a Wilcoxon rank-sum test.

Table 4. Multivariable regression for predictors of adjusted total hospital cost.

	Adjusted total hospital cost
	Coefficient	Standard error	p-value
Cohort (ref: group 1)
Group 2	−1,210,711.42	584,231.58	0.0392
Gender (ref: male)
Female	−1,008,404.41	641,298.52	0.1171
BMI (kg/m^2) (ref: ≥ 25.0)
<18.5	5,189,553.38	1,937,702.90	0.0079
18.5–22.9	−650,649.88	644,595.95	0.3137
23.0–24.9	−798,446.80	695,472.36	0.2520
Pulmonary disease (ref: no)
Yes	8,000,292.88	1,857,321.73	<.0001
FEV1 (L)	−524,878.12	436,688.11	0.2305
Plueral adhesion (ref: no)
Yes	1,596,938.99	857,795.99	0.0638
Tumor location (ref: RUL)
RML	−828,400.79	1,111,909.34	0.4569
RLL	1,518,325.43	735,574.03	0.0400
LUL	2,607,208.86	801,209.72	0.0013
LLL	−119,010.24	750,463.52	0.8741
TNM AJCC stage (pTNM) (ref: I)
II	−1,054,498.50	790,768.66	0.1835
III	598,860.11	921,263.17	0.5162
R^2	0.2370
Observation	271