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Redefining Coronary Artery Bypass: Real-world Outcomes Of Robotic And Non-robotic Coronary Revascularization
Bob Kiaii1, Husam Balkhy2, Johannes Bonatti3, Alexander deGroot4, Tessa Runels4, Usha Kreaden4.
1University of Calgary, Calgary, AB, Canada, 2University of Chicago, Chicago, IL, USA, 3UPMC, Pittsburgh, PA, USA, 4Intuitive Surgical, Sunnyvale, CA, USA.
BACKGROUNDAs robotic-assisted coronary artery bypass grafting (CABG) surpasses two decades as an alternative, minimally invasive modality for surgical coronary artery revascularization, contemporary real-world comparative outcomes studies remain limited. This study assesses whether robotic-assisted CABG is associated with improved perioperative outcomes and resource utilization compared with non-robotic CABG in a real-world, national cohort from 2016 to 2023.
METHODSThis matched comparative study used the Premier Healthcare Database. Adult patients (≥18 years) undergoing primary single- or double-vessel internal mammary artery CABG between 2016 and 2023 were identified using ICD-10 procedure codes. Exclusion criteria included prior CABG, concomitant valve surgery, percutaneous coronary intervention, left atrial appendage occlusion, missing covariates, and extreme operating room times (>1.5× interquartile range). Robotic procedures were identified using ICD-10 procedure codes, CPT codes, or billing records indicating robotic instrumentation. One-to-one nearest neighbor propensity score matching was performed on age, sex, race, obesity, smoking history, Charlson Comorbidity Index (CCI), elective status, admission year, cardiopulmonary bypass use, and peripheral vascular disease.
RESULTSAfter matching, 2,721 robotic and 2,721 non-robotic CABG cases were analyzed with well-balanced baseline characteristics. Robotic CABG was associated with longer operating times (300 vs. 270 minutes, p<0.001) but significantly shorter total hospital length of stay (5 vs. 6 days), post-procedure length of stay, and ICU length of stay (all p<0.001). Robotic procedures demonstrated lower rates of in-hospital mortality (0.5% vs. 1.3%, p <0.001), 30-day mortality (0.7% vs. 1.5%, p=0.009), blood transfusion (8.9% vs. 14.2%, p<0.001), cardiac arrest (0.3% vs 0.8%, p=0.003), renal failure (7.1% vs 10.6%, p<0.001), and new-onset atrial fibrillation (15.0% vs. 18.2%, p=0.001). Discharge to home was more frequent following robotic CABG (90.8% vs. 84.7%, p<0.001). Thirty-day readmission was higher in the robotic group (8.7% vs. 6.6%, p=0.004). Rates of stroke, myocardial infarction, infection, and reoperation were similar between groups.
CONCLUSIONSIn this large contemporary real-world analysis, robotic CABG was associated with longer operative times but demonstrated significant advantages in mortality, postoperative recovery, renal outcomes, atrial fibrillation, and likelihood of discharge to home. These findings support the safety and potential clinical benefits of robotic CABG in appropriately selected patients.
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