Postoperative Day 1 Discharge After Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Enhanced Recovery After Surgery

Abstract

Objective: The benefits of Enhanced Recovery After Surgery (ERAS) protocols are being recognized in multiple surgical specialties, including following coronary bypass surgery to improve quality of care and decrease costs. We developed a fast-track discharge protocol for patients undergoing robotic totally endoscopic coronary bypass surgery (TECAB) to be discharged on postoperative day (POD) 1, the subjects of this study. Methods: In a retrospective study of 720 patients undergoing robotic beating-heart TECAB over 8 years at our institution, 93 patients were selected for a fast-track POD1 discharge protocol. We compared the outcomes of this group to the remaining 627 patients who were discharged per standard protocol (non-POD1 discharge). Results: The early discharge group was significantly younger, had lower Society of Thoracic Surgeons (STS) risk of mortality, and had a lower prevalence of obesity, diabetes, and chronic kidney disease. Patients discharged on POD1 were more often extubated in the operating room (56% vs 42%, P = 0.010). The readmission rate for the early discharge group was 3.2%, which was similar to the readmission rate of 6.7% for the standard discharge protocol group ( P = 0.329). Time to return to work was shorter in the early discharge group, although it did not quite reach statistical significance (12 vs 18 days, P = 0.051). There was no difference in midterm cardiac mortality. Conclusions: Early discharge on POD1 after robotic TECAB is appropriate in selected patients and is associated with low readmission rates and a trend towards earlier return to work. Patients suitable for this “ultrafast-track” approach were more likely to be younger, have lower STS risk, and fewer comorbidities.

The 7 Pillars of Starting an Endoscopic Cardiac Surgery Program

“…The rewards to patients are more than just a better cosmetic result, particularly when combined with the principles of enhanced recovery. 25 We hope this article brings together the combined knowledge of what has helped us in achieving this shift. There are many ways to move toward an endoscopic cardiac surgery practice, and we hope the reader will find this article helpful and start the process soon.…”

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

“…A further development of this approach is the robotic total endoscopic coronary artery bypass (TECAB) technique which provides multivessel revascularization without an open incision through port access ( 86 ). Aim of these less invasive approaches is to reduce the post-operative complications, reduce the surgical trauma and accelerate discharge timing ( 88 ).…”