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Published on: February 26, 2013
Effect of Preoperative Atrial Fibrillation on Postoperative Outcome following Cardiac Surgery
Nael Al-Sarraf1, Lukman Thalib, Anne Hughes
1Department of Cardiothoracic Surgery, St. James's Hospital, Dublin 8, Ireland.
Insights
Preoperative atrial fibrillation significantly increases mortality and major complications in cardiac surgery patients. Early intervention or specific surgical strategies may improve outcomes for these high-risk individuals.
Area of Science:
- Cardiology
- Cardiac Surgery
- Arrhythmia Research
Background:
- Atrial fibrillation is the most frequent arrhythmia in cardiac surgery patients.
- Limited data exist on the impact of preoperative atrial fibrillation on postoperative outcomes.
- Understanding these risks is crucial for patient management and surgical planning.
Purpose of the Study:
- To evaluate the effect of preoperative atrial fibrillation on postoperative outcomes in patients undergoing cardiac surgery.
- To identify specific complications associated with preoperative atrial fibrillation.
- To inform surgical strategies for patients with this condition.
Main Methods:
- Retrospective review of prospectively collected data from 3777 cardiac surgery patients over 8 years.
- Cohort divided into atrial fibrillation (n=413) and sinus rhythm (n=3364) groups.
- Analysis of postoperative complications and in-hospital mortality using univariate and multiple logistic regression, adjusting for Euro SCORE.
Main Results:
- Patients with preoperative atrial fibrillation had significantly higher mortality and major complication rates.
- Preoperative atrial fibrillation independently increased the risk of mortality (OR 1.7), low cardiac output (OR 1.3), prolonged ventilation (OR 1.4), infections (OR 1.5), gastrointestinal issues (OR 2.0), and ICU readmission (OR 1.6).
Conclusions:
- Preoperative atrial fibrillation is a significant risk factor for adverse outcomes and mortality after cardiac surgery.
- The findings highlight the need for careful preoperative assessment and management of atrial fibrillation.
- Surgical interventions like the Cox-Maze procedure may offer benefits to this patient group.
Abstract:
Atrial fibrillation remains the commonest arrhythmia encountered in cardiac surgery. Data on the effect of preoperative atrial fibrillation on postoperative outcome remain limited. We sought to assess the effects preoperative atrial fibrillation on patients' outcome following cardiac surgery. This is a retrospective review of prospectively collected departmental data of all patients who underwent cardiac surgery over 8-year period. Our cohort consisted of 3777 consecutive patients divided into atrial fibrillation (n = 413, 11%) and sinus rhythm (n = 3364, 89%). Postoperative complications and in-hospital mortality were analysed. Univariate analysis showed significantly increased mortality and major complications in atrial fibrillation compared to sinus rhythm patients. Using multiple logistic regression analysis and after accounting for Euro SCORE as a confounding variable, we found that preoperative atrial fibrillation significantly increases the risk of mortality (OR 1.7), low cardiac output state (OR 1.3), prolonged ventilation (OR 1.4), infective complication (OR 1.5), gastrointestinal complications (OR 2.0), and intensive care unit readmission (OR 1.6). Preoperative atrial fibrillation in cardiac surgery patients increases their risk of mortality and major complications following cardiac surgery. Surgical strategies such as Cox-Maze procedure may be beneficial in these patients.
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