The Effect of Body Mass Index on Outcomes Comparing Robotic to Non-robotic Approach for Anatomic Pulmonary Resections
Gal Levy, Matthew Van Deusen, Joseph H. Houda, Lana Y. Schumacher, Allegheny General Hospital, Pittsburgh, PA
OBJECTIVE: Robotic assisted lobectomy is shown to be safe in obese patients with BMI > 30. We investigate whether there is a difference between robotic, and non-robotic (NR) approach to anatomic lobectomies and segmentectomies in this population
METHODS: Retrospective single institution review of all patients who underwent a robotic, VATS or open thoracotomy for lung resection between 4/2015-3/2017 with surgeons who were experienced > 5 years with surgical approach. Patients were grouped according to the definition of obesity (BMI >30 kg/m2) defined by the World Health Organization. We compare perioperative outcomes, and post operative complication rates
RESULTS: There were 255 patients identified having undergone thoracic procedures. Of those, 90 patients had BMI > 30. Forty patients underwent a robotic approach with one conversion to open thoracotomy. Of the remaining 50 patients, 8 had an open thoracotomy approach and 42 underwent VATS with 8 converted from VATS to open (2.5% vs 19% p=0.01). There were no differences in robot vs NR between mean BMI (35.27 vs 35.3, p=0.50), or length of stay (LOS) (3.95 days vs 4.72, p=0.06). The ICU admissions were higher for non-robotic patients (66% vs 25%, p<0.05) (Table 1).
CONCLUSIONS: In patients with BMI > 30, length of stay and 30 day mortality were equivalent between robotic and NR lung resections with higher rates of conversion and longer ICU days in NR patients. Robotic lung resection compared to NR approach is equivalent in outcomes with fewer ICU admissions and lower conversion to thoracotomy rates.
|Table 1: Differences in Robotic and Nonrobotic Outcomes|
|Robot (N)||Non-Robot (N)||P-value|
|30 day mort||0(40)||1(50)||1|
|Conversions to open||1(40)||8(42)||<0.05|