Perioperative risk assessment, in robotic general surgery: Lessons learned from 884 cases at a single institution

Abstract

Objective: To assess factors associated with morbidity and mortality following the use of robotics in general surgery. Design : Case series. Setting: University of Illinois at Chicago. Patients and Intervention: Eight hundred eightyfour consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. Main Outcomes Measures: Perioperative morbidity and mortality. Results: During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patientrelated (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥3, body mass index [calculated as weight in kilograms divided by height in meters squared] <30, age ≥70 years, and malignant disease) or procedure-related (blood loss ≥500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality. Conclusions: Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery. ©2012 American Medical Association. All rights reserved.