Feasibility of Postoperative Day One or Day Two Discharge After Robotic Cardiac Surgery

• Published in: The Journal of surgical research 2023-09, Vol.289, p.35-41
• Main Authors: Yost, Colin C., Rosen, Jake L., Mandel, Jenna L., Wong, Daniella H., Prochno, Kyle W., Komlo, Caroline M., Ott, Nathan, Goldhammer, Jordan E., Guy, T. Sloane
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Surgical Procedures - adverse effects; Early discharge; Enhanced recovery after surgery; Feasibility Studies; Female; Heart; Humans; Male; Minimally invasive cardiac surgery; Patient Discharge; Robotic cardiac surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.03.019

The robotic platform reduces the invasiveness of cardiac surgical procedures, thus facilitating earlier discharge in select patients. We sought to evaluate the characteristics, perioperative management, and early outcomes of patients who underwent postoperative day 1 or 2 (POD1-2) discharge after robotic cardiac surgery at our institution. Retrospective review of 169 patients who underwent robotic cardiac surgery at our facility between 2019 and 2021 identified 57 patients discharged early on POD1 (n = 19) or POD2 (n = 38) and 112 patients who underwent standard discharge (POD3 or later). Relevant data were extracted and compared. In the early discharge group, median patient age was 62 [IQR: 55, 66] (IQR = interquartile range) years, and 70.2% (40/57) were male. Median Society of Thoracic Surgeons predictive risk of mortality score was 0.36 [IQR: 0.25, 0.56] %. The most common procedures performed were mitral valve repair [66.6%, (38/57)], atrial mass resection [10.5% (6/57)], and coronary artery bypass grafting [10.5% (6/57)]. The only significant differences between the POD1 and POD2 groups were shorter operative time, higher rate of in-operating room extubation, and shorter ICU length of stay in the POD1 group. Lower in-hospital morbidity and comparable 30-day mortality and readmission rates were observed between the early and standard discharge groups. POD1-2 discharge after various robotic cardiac operations afforded lower morbidity and similar 30-day readmission and mortality rates compared to discharge on POD3 or later. Our findings support the feasibility of POD1-2 discharge after robotic cardiac surgery for patients with low preoperative risk, an uncomplicated postoperative course, and appropriate postoperative management protocols. •POD1-2 discharge was feasible after a variety of robotic cardiac surgery operations.•POD1-2 discharge was associated with no 30-day mortality and few readmissions.•30-day mortality and readmission rates were similar for early versus standard discharge.•Early mechanical ventilation discontinuation may facilitate POD1-2 discharge.•Multidisciplinary perioperative protocols are crucial to POD1-2 discharge.