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Next Day Discharge After Robotic Cardiac Surgery: Combining Early Recovery After Surgery (eras) With An Endoscopic Surgical Approach
Sarah Nisivaco, Hiroto Kitahara, Brooke Patel, Charocka Coleman, Husam H. Balkhy.
University of Chicago Medicine, Chicago, IL, USA.
BACKGROUND: The benefits of Early Recovery after Surgery (ERAS) protocols are increasingly recognized in multiple surgical specialties, including cardiac surgery to improve quality of care and decrease costs. We developed a fast-track discharge protocol for patients undergoing robotic endoscopic cardiac surgery to be discharged on post-operative (POD) 1, the subjects of this study. We report on the preoperative characteristics and early outcomes of this cohort.
METHODS: In a retrospective review of 2025 patients undergoing robotic endoscopic cardiac surgery at our institution between 7/2013-12/2025, 315 patients were selected for a next day discharge protocol based on preoperative characteristics including age, STS risk, comorbidities, and family support. An ERAS protocol was charted, and close post operative follow-up was conducted by our outpatient team.
RESULTS: Of 315 patients discharged the next day after robotic endoscopic cardiac surgery, 213 patients had an epicardial off-pump procedure (162 TECAB, 20 myocardial bridge unroofing, and 13 other); 102 patients had an intracardiac procedure (82 MV, 5 isolated cryo-maze, 2 AVR, 12 other). Mean age was 60.6+13 years; mean STS risk was 1.06+1.2. Incidence of obesity (BMI >30), diabetes, and chronic kidney disease was 32%, 19%, and 8.3%, respectively. OR extubation occurred in 47%; only 3.5% received a blood transfusion at any time. 30-day mortality was 0; readmission occurred in 2.9%. Incidence of new POAF at 6-weeks was 1.8%, and pleural effusion requiring drainage occurred in 1.6%. Mean time to return to full activities was 13+8 days.
CONCLUSIONS: Next-day discharge after robotic endoscopic cardiac surgery is appropriate in select patients undergoing both on and off-pump endoscopic cardiac procedures. In our experience, it was associated with low perioperative morbidity and re-admission rates and early return to activities.
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