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Enhanced Recovery After Coronary Bypass Surgery In Morbidly Obese Patients: Impact Of A Robotic Totally Endoscopic Approach
Riya Bhasin, Sarah Nisivaco, Hiroto Kitahara, Charocka Coleman, Husam H. Balkhy.
The University of Chicago, Chicago, IL, USA.
BACKGROUND: Morbid obesity is a well-recognized risk factor in patients with coronary artery disease and is associated with adverse postoperative outcomes after coronary artery bypass grafting, including prolonged hospital length of stay. Given the importance of optimizing recovery in high-risk populations, we evaluated early and midterm outcomes in morbidly obese patients undergoing robotic totally endoscopic coronary artery bypass (TECAB).
METHODS: Between July 2013 and December 2025, 1,008 patients underwent robotic, beating-heart TECAB within an enhanced recovery after surgery (ERAS) protocol at our institution. Of these, 171 were morbidly obese, defined as a body mass index (BMI) ≥ 35. Sub-analysis was completed for 71 patients with a BMI ≥ 40. Perioperative and postoperative outcomes were analyzed.
RESULTS: Mean age in the morbid obesity group (BMI ≥ 35) was 63±9 with 35% female. Mean STS predicted risk of mortality was 1.8±2.5 and BMI was 39.6±4.4. There was one conversion to sternotomy and no wound infections. Postoperative complications were low, including new atrial fibrillation in 8% with no myocardial infarction (MI) or stroke. Mean hospital and ICU lengths of stay were 2.3 ± 0.8 and 1.2 ± 0.6 days, respectively, and 12% of patients were discharged on POD #1. At 30-day follow-up, mortality was 2% and readmission occurred in 6%. Midterm follow-up was complete at mean 49±39 months in 99% of patients. Freedom from MACCE was 89%. In the BMI ≥ 40 group sub-analysis, patients had a significantly higher mean STS risk score of 2.3±2.8 but demonstrated comparable perioperative outcomes, including hospital and ICU lengths of stay of 2.4±0.9 and 1.3±0.7 days, respectively. There were no wound infections, MI, or stroke, and 30-day mortality was 1%. Prolonged intubation (> 24 hours) occurred in 6%. Mean return to activity was 18±13 days. Midterm follow-up was complete at mean 54±39 months in 100% of patients, with 89% freedom from MACCE.
CONCLUSIONS: Robotic, beating heart TECAB is safe and effective in morbidly obese patients, with low mortality and complication rates within an ERAS pathway. These findings support the greater adoption of robotic cardiac surgery and ERAS in high-risk patients.
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