Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, 200 Lothrop Street C-718, Pittsburgh, PA, 15123, USA.
Department of Radiology, University of Pittsburgh School of Medicine, UPMC Heart and Vascular Institute, Pittsburgh, PA, USA.
J Robot Surg. 2024 Nov 5;18(1):395. doi: 10.1007/s11701-024-02112-4.
Little is known about the incidence of subcutaneous emphysema (SE) after robotic cardiac surgery. The aim of this study was to describe the incidence, identify risk factors, and assess its influence on postoperative outcomes. Patients undergoing robotic mitral valve repair (n = 63, 54.3%), robotic minimally invasive direct coronary artery bypass grafting (n = 23, 19.8%), and robotic totally endoscopic coronary artery bypass grafting (n = 30,25.9%) were included in the analysis (total n = 116). Subcutaneous emphysema occurred in 53/116 patients (45.7%). It was mild in 30/53 patients (56.6%), moderate in one patient (1.9%), and severe in 22/53 patients (41.5%). Low body weight (p = 0.009), low BMI (p = 0.006), small body surface area (p = 0.01), and older age (p = 0.041) significantly correlated with SE. Patients undergoing robotic mitral valve repair were affected more often than patients undergoing robotic coronary artery bypass grafting (p = 0.04). Severe subcutaneous emphysema resulted in an increased need for CT-chest imaging (p = 0.026), and additional chest tubes (p = 0.029). Severe emphysema was highly associated with pneumothorax (p < 0.001) and increased duration of chest tube drainage (p = 0.003). Subcutaneous emphysema after robotic heart surgery occurs preferentially in patients with low body weight, low BMI, a small body surface area, and older age and is more common in robotic MVR than in robotic coronary artery bypass surgery. It leads to an increased need for thoracic imaging and additional chest tube insertion. Clinical outcomes are not affected.
机器人心脏手术后皮下气肿（SE）的发生率尚不清楚。本研究旨在描述其发生率、确定危险因素，并评估其对术后结果的影响。共纳入 63 例（54.3%）机器人二尖瓣修复术、23 例（19.8%）机器人微创直接冠状动脉旁路移植术和 30 例（25.9%）机器人全内镜冠状动脉旁路移植术患者（共 116 例）进行分析。116 例患者中有 53 例（45.7%）发生皮下气肿。30 例（56.6%）为轻度，1 例（1.9%）为中度，22 例（41.5%）为重度。低体重（p=0.009）、低 BMI（p=0.006）、小体表面积（p=0.01）和高龄（p=0.041）与 SE 显著相关。与机器人冠状动脉旁路移植术相比，机器人二尖瓣修复术患者更易发生 SE（p=0.04）。重度皮下气肿导致更频繁地进行 CT 胸部成像（p=0.026）和需要更多的胸腔引流管（p=0.029）。重度肺气肿与气胸高度相关（p<0.001），并导致胸腔引流管引流时间延长（p=0.003）。机器人心脏手术后皮下气肿更易发生于低体重、低 BMI、小体表面积和高龄患者中，且在机器人二尖瓣修复术患者中比机器人冠状动脉旁路移植术患者中更为常见。它导致更频繁地进行胸部成像和需要插入更多的胸腔引流管。临床结局不受影响。
