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Wireless Technology Demonstrates that Physical Capabilities in the Early Phase of Recovery are Enhanced by Less Invasive, Robotic CABG
Robert S. Poston, Jr..
Northwest medical center, Tucson, AZ, USA.

OBJECTIVE: Prolonged recovery time is a major shortcoming of standard CABG (st-CABG) that drives the search for non-sternotomy alternatives. Subjective reports about less invasive CABG using robotics (r-CABG) suggest an improved recovery time. However, an objective, head-to-head comparison against st-CABG is lacking. We compared patients that underwent either st-CABG vs. r-CABG using a series of objective measures of recovery time.
METHODS: Inclusion criteria for this prospective study of postoperative recovery included all patients with an STS risk score < 2% undergoing CABG via sternotomy vs. robotic techniques at a single center. Daily distance walked was monitored for the first two weeks after surgery as an inpatient and outpatient using a wireless tracking device (Fitbit™, San Francisco, CA). Before and at 3 weeks after CABG, each subject was tested for exercise tolerance at maximal (treadmill maximum 02 consumption, MVO2) and submaximal effort (distance in the 6-minute walk test) and surveyed by the Duke Activity Status Index (DASI). Postop results were normalized against baseline values.
RESULTS: A total of 40 CABG patients (20 patients in each group) were recruited over a 2 year enrollment period. While both groups showed steady daily improvement in their walking distances, the r-CABG group walked 3-fold longer during the 2 week evaluation period (0.5±1.0 vs. 1.7±1.5 miles/day, p=0.02). At 3 weeks after surgery, the st-CABG group showed 43±38% recovery in MVO2, 56±31% recovery in 6 min walk test and 47±29% in DASI scores. The r-CABG group showed a statistically significant improvement in DASI score vs. st-CABG (97±56% recovery, p=0.04, heteroscedastic t-test). Most r-CABG patients showed a full recovery at 3 weeks in MVO2 (93±23%), 6 min walk distance (96±28%), but this was not statistically significant because of more variability in performance between patients.
CONCLUSIONS: In low risk patients, our study showed that smaller surgical incisions were associated with a quicker recovery of submaximal effort (e.g. daily walking distance, DASI score). Such an advantage documents the societal benefit of r-CABG because it usually translates into quicker return to work and less absenteeism, providing a strong financial rationale for this procedure.


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