That still saves the time of: a) remembering that the flag is stale and must be removed, b) actually removing the code and putting the diff up. Piranha diffs for a single flag are also generally small enough to fully read them during code review.
We do have comprehensive unit tests for both the Piranha tool and the target codebase(s), and the majority (65%) of diffs generated by Piranha are landed without changes (and the most common change in those that are changed is to delete extra lines that Piranha couldn't prove as stale). Thus far we haven't had an outage caused by a Piranha deletion, but certainly there have been incorrect diffs generated and caught either by CI or manual reviewers, requiring us to update the tool. We would not recommend landing diffs generated by Piranha - or other stale code removal tools - to master without any reviews right now :)