(163) Trends in Adoption of Knotless Tissue Control Devices in Robotic Surgery: A Retrospective Database Analysis

Background: Trends in the use and comparative outcomes for barbed and conventional (smooth) sutures have not been well-reported for robotic surgery.

Objectives: To examine quarterly trends in use of barbed sutures, (specifically, STRATAFIX™ knotless tissue control devices [KTCD]) during common robotic surgeries in the U.S. and compare clinical and economic outcomes between KTCD and smooth sutures.

Methods: This retrospective, observational cohort study used discharge-level data from the Premier PINC AI™ Healthcare Data. Study subjects were age ≥18 years and had a robotic surgical admission for colorectal surgery (CR), total hysterectomy (TH), or ventral hernia repair (VHR) performed between 10/01/2015-06/30/2022. Outcomes included wound-related complications (infection/wound dehiscence) through 90 days post-discharge, operating room (OR) time, total hospital costs, and 30-, 60-, and 90-day all-cause inpatient readmissions. Propensity score weighting was used to address potential confounding in the comparisons of outcomes, performed separately for each procedure. Descriptive statistics were used to evaluate quarterly KTCD utilization trends as a proportion of all robotic procedures for the time from Q4 2015 through Q2 2022. Generalized linear models, accounting for hospital-level clustering, with link functions and error distributions tailored to the empirical distribution of outcomes were used to test for statistically significant differences in outcomes between the KTCD and smooth suture cohorts.

Results: We identified 15,875 patients with CR (668 KTCD), 175,963 patients with TH (15,075 KTCD), and 32,469 with VHR (6,776 KTCD). Over the study period, the proportion of robotic surgeries using KTCD tripled for CR (1.95% to 6.40%) and TH (2.94% to 10.38%) and more than doubled for VHR (12.2% to 25.3%). Compared with smooth sutures, KTCD was associated with significantly shorter OR time for TH (19.1 minutes, 95% CI [-30.2, -8.0]) and VHR (17.3 minutes, 95% CI [-31.4, -3.2]), and was numerically shorter, but did not reach statistical significance for CR (23.2 minutes 95% CI [-48.1 to 1.7]). All other clinical and economic outcomes assessed were similar between the two suture cohorts for all procedures apart from CR 90-day readmissions which were lower for the KTCD cohort (2.8%, 95% CI [-5.2% to -0.4%]).

Conclusions: Adoption of KTCD has grown substantially over the past 6 years. While most clinical and economic outcomes were similar between the two groups, KTCD was associated with lower operating room time vs. smooth sutures for TH and VHR and lower 90-day readmissions for CR.