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Central Surgical Association

49th Annual Meeting

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Early discharge on postoperative day one or two following robotic cardiac surgery: a single-center, retrospective review
Colin C. Yost1, Jake L. Rosen1, Jenna Mandel1, Daniella Wong1, Kyle Prochno1, Caroline M. Komlo2, Nathan Ott1, Jordan E. Goldhammer3, T S. Guy4
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States, 2Section of Cardiothoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, United States, 3Department of Anesthesia, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States, 4Department of Surgery, Division of Cardiac Surgery, Philadelphia, Pennsylvania, United States

Objective: The robotic platform allows for dramatically minimized invasiveness of cardiac surgical procedures, thus decreasing postoperative pain and facilitating earlier discharge in select patients. We sought to evaluate the characteristics of patients who underwent post-operative day one (POD1) or two (POD2) discharge after robotic cardiac surgery at our institution.

Methods: A retrospective review of 171 patients who underwent robotic cardiac surgery at our facility between 2019 and 2021 was performed. 57 patients discharged on POD1 (n = 19) or POD2 (n = 38) were identified, and relevant data were extracted and analyzed.

Results: Median patient age was 62 [55, 66] years, and 70.2% (40/57) were male. The most common preoperative comorbidities were hypertension [49.1% (28/587], coronary artery disease [21.1% (12/57)], and atrial fibrillation [19.3% (11/57)]. Median Society of Thoracic Surgeons predictive risk of mortality score was 0.36 [0.25, 0.56] %, and median preoperative ejection fraction was 63 [60, 65]%. The most common procedures performed were mitral valve repair [66.6, (38/57)], atrial mass resection [10.5% (6/57)], and coronary artery bypass grafting [10.5% (6/57)]. Median operative time was 267 [242, 305] minutes, and median cardiopulmonary bypass (CPB) time was 109 [95, 128] minutes among the 54 operations utilizing CPB. Blood transfusion was required intraoperatively in 10.5% (6/57) of patients and postoperatively in 17.5% (10/57). Most patients [82.5% (47/57)] were extubated in the operating room. Among the 10 patients extubated in the ICU, median length of postoperative intubation was 6 [5, 6] hours; no patients required reintubation. Median ICU length of stay was 22 [18, 28] hours. The only postoperative events observed were two patients with atrial fibrillation. All patients were discharged home and alive at 30 days. Thirty-day readmission rate was 8.8% (5/57). Reasons for readmission included respiratory dysfunction [60.0% (3/5)], chest wall cellulitis [20.0%, (1/5)], and right PCA stroke [20.0% (1/5)]. The patient readmitted for stroke was treated with immediate thrombectomy and sustained no neurological deficits aside from a slight left upper visual field cut.

Conclusion: In this single-center retrospective review, patients who underwent POD1-2 discharge after a variety of robotic cardiac operations generally had a low preoperative risk of mortality and an uncomplicated postoperative course. Most patients were extubated in the operating room, suggesting early discontinuation of mechanical ventilation could be a key driver of early discharge. Discharge to home on POD1-2 was associated with no 30-day mortality and few readmissions within 30 days. Overall, our results suggest that POD1-2 discharge after robotic cardiac surgery is a safe and practical option for appropriate patients.

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