Effect of minimally invasive cardiac surgery on hospital length of stay: A systematic review and meta-analysis

Keywords:

Enhanced recovery, minimally invasive, cardiac surgery, valve replacement, coronary bypass, ERACS


Published online: Sep 02 2024

https://doi.org/10.56126/75.3.52

D.F. Hoogma1,2,*, T. van Bos1, F. Polfliet3, P. Verbrugghe2,4, W. Oosterlinck2,4, J. Van den Eynde2, S. Rex1,2

1 University Hospitals Leuven, Department of Anesthesiology, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
2 University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
3 Jessa Hospital, Department of Anesthesiology, Stadsomvaart 11, 3500 Hasselt, Belgium
4 University Hospitals Leuven, Department of Cardiac Surgery, KU Leuven, Herestraat 49, 3000 Leuven, Belgium

Abstract

Background: Perioperative management using minimally invasive cardiac surgery (MICS), compared to full sternotomy (FS) cardiac surgery, is considered to improve postoperative recovery, and reduce hospital length of stay (LOS).

Methods: A comprehensive systematic search was conducted across MEDLINE/PubMed, Embase, and the Cochrane library to identify RCT comparing MICS to FS approach for aortic valve, mitral valve, and coronary artery bypass surgery. Meta-analysis of extracted data was performed using random effects models.

Results: A total of 33 RCTs including 2920 patients were identified. Overall MD (95% CI) for hospital and intensive care unit (ICU) LOS after MICS was significantly shorter compared to FS (-0.88 days (-1.55;-0.20), p<0.013; 2606 patients) and (-0.23 days (-0.41;-0.05), p=0.012; 2242 patients), respectively. Additionally, postoperative blood loss was reduced with the use of MICS, (-192.07 ml (-292.32;-91.82), p=0.002; 718 patients). There was no evidence for differences between both groups in terms of postoperative ventilation times, duration of surgery, reintervention rate, incidence of postoperative atrial fibrillation or stroke, hospital mortality, or 1-year mortality.

Conclusion: Within the limitations of a meta-analysis, MICS was found to be effective in promoting faster recovery by reducing postoperative blood loss, ICU, and hospital LOS.

ActaAnaestBelg-75-i3-Cover

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Volume 75, issue 3.

Sep 2023.

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