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The Learning Curve of Robotic Coronary Arterial Bypass Surgery: A Report From The STS Database
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  • William Patrick,
  • Amit Iyengar,
  • Jason Han,
  • Jarvis Mays,
  • Mark Helmers,
  • John Kelly,
  • Xingmei Wang,
  • Mehrdad Ghoreishi,
  • Bradley Taylor,
  • Pavan Atluri,
  • Nimesh Desai,
  • Matthew Williams
William Patrick
University of Pennsylvania
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Amit Iyengar
University of Pennsylvania
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Jason Han
Hospital of the University of Pennsylvania
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Jarvis Mays
University of Pennsylvania
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Mark Helmers
University of Pennsylvania
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John Kelly
University of Pennsylvania
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Xingmei Wang
University of Pennsylvania
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Mehrdad Ghoreishi
University of Maryland School of Medicine
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Bradley Taylor
University of Maryland School of Medicine
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Pavan Atluri
University of Pennsylvania
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Nimesh Desai
University of Pennsylvania
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Matthew Williams
University of Pennsylvania
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Abstract

Background: There is limited data to inform minimum case requirements for training in robotically-assisted coronary artery bypass grafting (RA-CABG). Current recommendations rely on non-clinical endpoints and expert opinion. Objectives: To determine the minimum number of RA-CABG procedures required to achieve stable clinical outcomes. Methods: We included isolated RA-CABG in The Society of Thoracic Surgeons (STS) registry performed between 2014 and 2019 by surgeons without prior RA-CABG experience. Outcomes were approach conversion, reoperation, major morbidity or mortality, and procedural success. Case sequence number was used as a continuous variable in logistic regression with restricted cubic splines with fixed effects. Outcomes were compared between operations performed earlier versus later in case sequences using unadjusted and adjusted metrics. Results: There were 1195 cases performed by 114 surgeons. A visual inflection point occurs by a surgeon’s 10th procedure for approach conversion, major morbidity or mortality, and overall procedural success after which outcomes stabilize. There was a significant decrease in the rate of approach conversion (7.7% and 2.5%), reoperation (18.9% and 10.8%), and major morbidity or mortality (21.7% and 12.9%), as well as an increase in rate of procedural success (72.9% and 85.3%) with increasing experience between groups. In a multivariable logistic regression model case sequences of >10 was an independent predictor of decreased approach conversion (OR 0.27, 95% CI 0.09 to 0.84) and increased rate procedural success (OR 1.96, 95% CI 1.00 to 3.84).

Peer review status:ACCEPTED

24 Jun 2021Submitted to Journal of Cardiac Surgery
24 Jun 2021Submission Checks Completed
24 Jun 2021Assigned to Editor
28 Jun 2021Reviewer(s) Assigned
11 Jul 2021Review(s) Completed, Editorial Evaluation Pending
16 Jul 2021Editorial Decision: Revise Minor
18 Jul 20211st Revision Received
19 Jul 2021Submission Checks Completed
19 Jul 2021Assigned to Editor
19 Jul 2021Reviewer(s) Assigned
27 Jul 2021Review(s) Completed, Editorial Evaluation Pending
27 Jul 2021Editorial Decision: Accept