Background To investigate the effect of body mass index (BMI) on clinical outcomes after robotic cardiac surgery, and to explore the postoperative obesity paradox. Methods The data of 146 patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (42.88 ± 13.01) years, 55 (37.67%) were male and 91 (62.33%) were female. Patients were divided into 3 groups according to preoperative BMI: lean group (BMI < 18.5 kg/m2; n = 17; 11.64%), normal group (BMI 18.5 kg/m2 to 23.9 kg/m2; n = 81; 55.48%), and overweight and obese group (BMI ≥ 24 kg/m2; n = 48; 32.88%). Multivariate analysis was performed to compare clinical outcomes across BMI groups. Results Preoperative data in different BMI groups showed that there were statistically significant differences in age, height, weight, body surface area (BSA), diabetes, left atrial anteroposterior diameter (LAD), triglyceride (TG), and high-density lipoprotein (HDL) (all P < 0.05). Postoperative clinical outcomes showed that there was no statistical difference between the lean group and the normal group; the intensive care unit stay and postoperative hospital stay in the overweight and obese group were significantly higher than those in the normal group (P < 0.05), and the risk of postoperative cardiac surgery-related acute kidney injury (CSA-AKI) was significantly increased (P = 0.021); further Multiple Binary Logistic Regression Analysis suggested that preoperative TG (OR = 1.772, 95% CI 1.068–2.942, P = 0.027) and operation time ≥ 300 min (OR = 3.823, 95% CI 1.098–13.308, P = 0.035) were independent risk factors for postoperative CSA-AKI. Conclusions Overweight and obese patients had significantly prolonged intensive care unit stay and postoperative hospital stay after robotic cardiac surgery, and significantly increased incidence of postoperative CSA-AKI, which did not support the obesity paradox; preoperative TG and operation time ≥ 300 min were independent risk factors for postoperative CSA-AKI.

Background:To analyze the safety and efficacy of Da Vinci robotic cardiac surgery, to investigate the risk factors of postoperative arrhythmia and to establish a risk prediction model. Methods:The data of 147 patients who underwent cardiac surgery under Da Vinci robotic cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (43.03±13.11) years, 55 (37.41%) were male and 92 (62.59%) were female. According to whether arrhythmia occurred after operation, the patients were divided into two groups: 23 patients with arrhythmia and 123 patients without arrhythmia. Univariate analysis was performed for perioperative risk factors in the two groups, and then multivariate logistic analysis was performed for selected variables with more significance to establish a regression model and evaluate the prediction model using receiver operating characteristic curve (ROC curve). Results: Arrhythmia occurred in 23 of 147 patients (15.75%) after Da Vinci robotic cardiac surgery, and 1 patient (0.68%) died in the hospital.Univariate analysis of arrhythmia after Da Vinci robotic cardiac surgery suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) class, left atrial anteroposterior diameter (LAD), left ventricular anteroposterior diameter (LVDs), right ventricular anteroposterior diameter (RVDs), total bilirubin (TBIL), direct bilirubin (DBIL), uric acid (UA), red blood cell width (RDW), operation time, CPB time, aortic cross-clamp time, and operation type were statistically analyzed and associated with postoperative arrhythmia (P<0.05).Multivariate binary logistic regression analysis suggested that DBIL (OR=1.334,95%CI1.003–1.774,P=0.048) and aortic cross-clamp time (OR=1.018,95%CI1.005–1.031,P=0.008) were independent risk factors for arrhythmia after Da Vinci robotic cardiac surgery.In arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002).The area under the curve (AUC) of ROC was 0.849 (95%CI0.769–0.930, P<0.001), the cutoff point was 0.574, the model sensitivity was 82.6%, and the specificity was 74.8%. Conclusion:Preoperative DBIL level and aortic cross-clamp time were independent risk factors of arrhythmia after Da Vinci robotic cardiac surgery; postoperative tracheal intubation time, intensive care unit stay and postoperative hospital stay were significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events were significantly increased; risk prediction model had certain predictive value for postoperative arrhythmia.

Background To analyze the safety and efficacy of Da Vinci robotic cardiac surgery, to investigate the risk factors of postoperative arrhythmia and to establish a risk prediction model. Methods The data of 147 patients who underwent cardiac surgery under Da Vinci robotic cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (43.03 ± 13.11) years, 55 (37.41%) were male and 92 (62.59%) were female. According to whether arrhythmia occurred after operation, the patients were divided into two groups: 23 patients with arrhythmia and 123 patients without arrhythmia. Univariate analysis was performed for perioperative risk factors in the two groups, and then multivariate logistic analysis was performed for selected variables with more significance to establish a regression model and evaluate the prediction model using receiver operating characteristic curve (ROC curve). Results Arrhythmia occurred in 23 of 147 patients (15.75%) after Da Vinci robotic cardiac surgery, and 1 patient (0.68%) died in the hospital.Univariate analysis of arrhythmia after Da Vinci robotic cardiac surgery suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) class, left atrial anteroposterior diameter (LAD), left ventricular anteroposterior diameter (LVDs), right ventricular anteroposterior diameter (RVDs), total bilirubin (TBIL), direct bilirubin (DBIL), uric acid (UA), red blood cell width (RDW), operation time, CPB time, aortic cross-clamp time, and operation type were statistically analyzed and associated with postoperative arrhythmia (P < 0.05).Multivariate binary logistic regression analysis suggested that DBIL (OR = 1.334,95%CI1.003–1.774,P = 0.048) and aortic cross-clamp time (OR = 1.018,95%CI1.005–1.031,P = 0.008) were independent risk factors for arrhythmia after Da Vinci robotic cardiac surgery.In arrhythmia group, postoperative tracheal intubation time (P < 0.001), intensive care unit stay (P < 0.001) and postoperative hospital stay (P < 0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P = 0.002).The area under the curve (AUC) of ROC was 0.849 (95%CI0.769–0.930, P < 0.001), the cutoff point was 0.574, the model sensitivity was 82.6%, and the specificity was 74.8%. Conclusion Preoperative DBIL level and aortic cross-clamp time were independent risk factors of arrhythmia after Da Vinci robotic cardiac surgery; postoperative tracheal intubation time, intensive care unit stay and postoperative hospital stay were significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events were significantly increased; risk prediction model had certain predictive value for postoperative arrhythmia.

Background To analyze the safety and efficacy of Da Vinci robotic cardiac surgery, to investigate the risk factors of postoperative cardiac surgery-associated acute kidney injury (CSA-AKI) and to establish a risk prediction model. Methods The data of 147 patients who underwent cardiac surgery under Da Vinci robotic cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Military Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (43.03 ± 13.11) years, 55 (37.41%) were male and 92 (62.59%) were female. Patients were divided into 2 groups according to whether CSA-AKI occurred after surgery: 37 patients developed CSA-AKI and 109 patients did not develop CSA-AKI. Univariate analysis was performed for perioperative risk factors in the two groups, and then multivariate logistic analysis was performed for selected variables with more significance to establish a regression model and evaluate the prediction model using receiver operating characteristic curve (ROC curve). Results 37 of 147 patients (25.34%) developed CSA-AKI after Da Vinci robotic cardiac surgery, 28 (19.18%) had stage 1 CSA-AKI, 6 (4.11%) had stage 2 CSA-AKI, 3 (2.05%) had stage 3 CSA-AKI, 1 (0.68%) had renal failure dialysis, and 1 (0.68%) died in the hospital.Univariate analysis of CSA-AKI after Da Vinci robotic cardiac surgery suggested that age, gender, obesity class, hypertension, smoking, alcohol consumption, New York Heart Association (NYHA) class, left atrial anteroposterior diameter (LAD), triglyceride (TG), high-density lipoprotein (HDL), alanine aminotransferase (ALT), creatinine (SCr), operation time, aortic cross-clamp time, CPB time, and operation type were statistically analyzed and associated with postoperative CSA-AKI (P < 0.05).Multivariate binary logistic regression analysis suggested that preoperative TG (OR = 1.756, 95%CI 1.058 ~ 2.914, P = 0.029) and operation time ≥ 300 min (OR = 3.649, 95%CI 1.061 ~ 12.553, P = 0.04) were independent risk factors for CSA-AKI after Da Vinci robotic cardiac surgery.In the CSA-AKI group, the postoperative tracheal intubation time (P < 0.001), intensive care unit stay (P = 0.004), and postoperative hospital stay (P = 0.002) were significantly prolonged, the incidence of postoperative pulmonary infection (P = 0.029), liver function injury (P = 0.045), and hypoproteinemia (P = 0.007) was significantly increased, and postoperative high-dose transfusion events were significantly increased (P = 0.002).The area under the curve (AUC) of ROC was 0.8 (95%CI 0.714 ~ 0.886, P < 0.001), the cutoff point was 0.456, the model sensitivity was 67.6%, and the specificity was 78%. Conclusion Preoperative TG and operation time ≥ 300 min were independent risk factors of CSA-AKI after Da Vinci robotic cardiac surgery; postoperative tracheal intubation time, intensive care unit stay and postoperative hospital stay were significantly prolonged in patients with postoperative CSA-AKI, the incidence of postoperative pulmonary infection, liver function injury and hypoproteinemia was significantly increased, and postoperative high-dose blood transfusion events were significantly increased; the risk prediction model had certain predictive value for postoperative CSA-AKI.