Background

This study explored the determinants/predictors of when bedside staplers were used in bariatric robotic procedures.

Methods

Patients who underwent bariatric robotic procedures between 1/1/2018 and 12/31/2022 were extracted from PINC AI™ Healthcare Data. Types of staplers were categorized into laparoscopic bedside staplers (LBS), unspecified bedside staplers (OBS), and robotic staplers (RS). Patient and surgeon characteristics were included as potential predictors to determine which stapler was used. Chi-square or Fisher exact test was used to examine bivariate association between potential predictors and type of staplers. Multinomial logistic regression model was used to identify the predictors.

Results

There were 40,770 eligible discharges, including 26.9% LBS, 10.1% OBS, and 63% RS cases. Gastric bypass (compared to sleeve gastrectomy) was more likely to have used LBS than RS (Relative risk ratio (RR) 1.40+-0.04, p<0.001). Patients with median-to-extreme disease severity (vs. minor severity) were more likely to have had LBS than RS (RR 1.20+-0.04, p<0.001). High-volume hospitals were more likely to have used LBS over RS (RR: 1.69+-0.05, p<0.001). Other predictors of LBS over RS included white and black patients, operations in the West region, rural areas, non-teaching status, hospitals over 500 beds, and low-volume surgeons. There was a greater utilization of RS over MBS in 2022 vs 2018.

Conclusions

The characteristics of predictors of LBS used over RS, such as severe cases and high-volume hospitals were found. More studies need to be done to understand the rationality behind the decision.