Risk factor analysis and risk prediction model of arrhythmia after Da Vinci robotic cardiac surgery

Abstract

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.