Subcutaneous emphysema in patients undergoing robotic cardiac surgery: risk factors and clinical outcome

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