title: In-hospital mortality and morbidity after robotic coronary artery surgery.
abstract: OBJECTIVE
  The objective of this study was to assess the impact of robotic approaches on outcomes of coronary bypass surgery.
  
  
  METHODS
  Retrospective national database analysis.
  
  
  METHODS
  United States hospitals.
  
  
  METHODS
  A weighted sample of 484,128 patients undergoing isolated coronary artery surgery identified from the Nationwide Inpatient Sample from 2008 through 2010.
  
  
  METHODS
  Robotically assisted coronary artery bypass surgery versus conventional bypass surgery.
  
  
  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.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Cavallaro
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, NY.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Rhee
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Chiang
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Seigerman
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY. Electronic address: Joannachikwe@mountsinai.org.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality* / Q000639:trends*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: CABG; coronary artery bypass grafts; robotics