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Published on: September 23, 2018
Association of Robotic Assistance With Short-term Outcomes After Coronary Artery Bypass Grafting
Arjun Verma1,2, Justin J Kim1, Sara Sakowitz1
1Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
Background:
Coronary artery bypass grafting (CABG) is traditionally performed though median sternotomy for multivessel coronary artery disease. Robotic CABG, a viable alternative, comprises less than 1% of CABG procedures in the United States despite its potential benefits. This study aimed to compare the trends and outcomes of conventional and robotic CABG by using a contemporary national cohort.
Methods:
A retrospective study was conducted using the 2016 to 2020 Nationwide Readmissions Database (NRD). Adult patients (aged ≥18 years) who underwent single-vessel CABG were identified using International Classification of Diseases, 10th revision procedure codes. Patients were categorized into robotic (totally endoscopic or robotic-assisted) and conventional CABG cohorts. Outcomes evaluated included in-hospital mortality, major adverse events (MAEs), length of stay, hospitalization costs, nonhome discharge, and 30-day readmissions.
Results:
Among 21,870 patients, 3433 (15.7%) underwent robotic CABG. The use of robotic CABG increased modestly over the study period. Patients who underwent robotic CABG had lower in-hospital mortality (0.4% vs 1.7%; P < .001) and MAEs (11.4% vs 18.9%; P < .001) compared with conventional CABG. Moreover, the robotic CABG cohort was associated with shorter length of stay and reduced hospitalization costs. After adjusting for baseline characteristics, robotic CABG showed lower odds of in-hospital mortality (adjusted odds ratio, 0.35; 95% CI, 0.15-0.84; P = .019) and MAEs (adjusted odds ratio, 0.72; 95% CI, 0.59-0.88; P = .001).
Conclusions:
Robotic CABG is associated with reduced in-hospital mortality, complications, LOS, and hospitalization costs compared with conventional CABG. Despite these benefits, its adoption remains limited, potentially because of the steep learning curve and resource requirements. Further efforts to overcome these barriers could enhance the adoption of robotic CABG and improve patient outcomes.
