Paul Cavallaro1, Amanda J Rhee2, Yuting Chiang1, Shinobu Itagaki1, Matthew Seigerman1, Joanna Chikwe3. 1. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY. 2. Department of Anesthesiology, Mount Sinai Medical Center, New York, NY. 3. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY. Electronic address: Joannachikwe@mountsinai.org.
Abstract
OBJECTIVES: The objective of this study was to assess the impact of robotic approaches on outcomes of coronary bypass surgery. DESIGN: Retrospective national database analysis. SETTING: United States hospitals. PARTICIPANTS: A weighted sample of 484,128 patients undergoing isolated coronary artery surgery identified from the Nationwide Inpatient Sample from 2008 through 2010. INTERVENTIONS: Robotically assisted coronary artery bypass surgery versus conventional bypass surgery. MEASUREMENTS AND MAIN RESULTS: Robotic approaches were used in 2,582 patients (0.4%). Patients undergoing robotic surgery were less likely to be female (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.87), present with acute myocardial infarction (OR 0.53, 95% CI 0.38-0.73), or have cerebrovascular disease (OR 0.41, 95% CI 0.23-0.71) compared to patients undergoing conventional surgery. In 59% of robotic cases, a single bypass was performed, and 2 bypasses were performed in 25% of cases. After adjusting for comorbidity, reduced postoperative stroke (0.0% v 1.5%, p = 0.045) and transfusion (13.5% v 24.4%, p = 0.001) rates were observed in patients who underwent robotic single-bypass surgery compared to conventional surgery. In patients undergoing multiple bypass grafts, higher mortality (1.1% v 0.5%), and cardiovascular complications (12.2% v 10.6%) were observed when robotic assistance was used, but the differences were not statistically significant (p = 0.5). The mean number of robotic cases carried out annually at institutions sampled was 6. CONCLUSIONS: Robotic assistance is associated with lower rates of postoperative complications in highly selected patients undergoing single coronary artery bypass surgery, but the benefits of this approach are reduced in patients who require multiple coronary artery bypass grafts.
OBJECTIVES: The objective of this study was to assess the impact of robotic approaches on outcomes of coronary bypass surgery. DESIGN: Retrospective national database analysis. SETTING: United States hospitals. PARTICIPANTS: A weighted sample of 484,128 patients undergoing isolated coronary artery surgery identified from the Nationwide Inpatient Sample from 2008 through 2010. INTERVENTIONS: Robotically assisted coronary artery bypass surgery versus conventional bypass surgery. MEASUREMENTS AND MAIN RESULTS: Robotic approaches were used in 2,582 patients (0.4%). Patients undergoing robotic surgery were less likely to be female (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.87), present with acute myocardial infarction (OR 0.53, 95% CI 0.38-0.73), or have cerebrovascular disease (OR 0.41, 95% CI 0.23-0.71) compared to patients undergoing conventional surgery. In 59% of robotic cases, a single bypass was performed, and 2 bypasses were performed in 25% of cases. After adjusting for comorbidity, reduced postoperative stroke (0.0% v 1.5%, p = 0.045) and transfusion (13.5% v 24.4%, p = 0.001) rates were observed in patients who underwent robotic single-bypass surgery compared to conventional surgery. In patients undergoing multiple bypass grafts, higher mortality (1.1% v 0.5%), and cardiovascular complications (12.2% v 10.6%) were observed when robotic assistance was used, but the differences were not statistically significant (p = 0.5). The mean number of robotic cases carried out annually at institutions sampled was 6. CONCLUSIONS: Robotic assistance is associated with lower rates of postoperative complications in highly selected patients undergoing single coronary artery bypass surgery, but the benefits of this approach are reduced in patients who require multiple coronary artery bypass grafts.
Authors: Christopher Cao; Praveen Indraratna; Mathew Doyle; David H Tian; Kevin Liou; Stine Munkholm-Larsen; Ciska Uys; Sohaib Virk Journal: Ann Cardiothorac Surg Date: 2016-11
Authors: Stepan Cerny; Wouter Oosterlinck; Burak Onan; Sandeep Singh; Patrique Segers; Cengiz Bolcal; Cem Alhan; Emiliano Navarra; Matteo Pettinari; Frank Van Praet; Herbert De Praetere; Jan Vojacek; Theodor Cebotaru; Paul Modi; Fabien Doguet; Ulrich Franke; Ahmed Ouda; Ludovic Melly; Ghislain Malapert; Louis Labrousse; Monica Gianoli; Alfonso Agnino; Tine Philipsen; Jean-Luc Jansens; Thierry Folliguet; Meindert Palmen; Daniel Pereda; Francesco Musumeci; Piotr Suwalski; Koen Cathenis; Jef Van den Eynde; Johannes Bonatti Journal: Front Cardiovasc Med Date: 2022-01-20