title: Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution.
abstract: OBJECTIVE
  To assess factors associated with morbidity and mortality following the use of robotics in general surgery.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University of Illinois at Chicago.
  
  
  METHODS
  Eight hundred eighty-four consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010.
  
  
  METHODS
  Perioperative morbidity and mortality.
  
  
  RESULTS
  During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patient-related (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥ 3, body mass index [calculated as weight in kilograms divided by height in meters squared] <30, age ≥ 70 years, and malignant disease) or procedure-related (blood loss ≥ 500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality.
  
  
  CONCLUSIONS
  Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery
authors.affiliation: Divisions of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Bianco
authors.forename: Veronica
authors.initials: V
authors.lastname: Gorodner
authors.forename: Subhashini M
authors.initials: SM
authors.lastname: Ayloo
authors.forename: Enrique F
authors.initials: EF
authors.lastname: Elli
authors.forename: José
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
authors.forename: Pier C
authors.initials: PC
authors.lastname: Giulianotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D055815:Young Adult