Postoperative Atrial Fibrillation in Patients Undergoing Non-Cardiac Surgery

Postoperative atrial fibrillation (POAF) occurs in approximately 5-10% of patients undergoing noncardiac surgery, yet its long-term impact compared to patients without POAF (nPOAF) remains uncertain. This study aimed to assess the incidence of cardiovascular outcomes in patients with new-onset POAF. A systematic search of PubMed, EMBASE, and Scopus up to August 2025 identified studies including adults who developed AF within the first postoperative week. Outcomes analyzed were AF recurrence, cardiac-related hospitalization, stroke, and all-cause mortality. Pooled analyses were performed using random-effects models, reconstructed time-to-event data, and Restricted Mean Survival Time (RMST). A total of 14 studies comprising 3,622,824 patients were included, with 61,305 experiencing POAF. Compared to nPOAF patients, POAF was associated with significantly higher risks of stroke at 1 year (HR 2.34, 95% CI, 1.46-3.21), in-hospital mortality (HR 3.29, 95% CI, 2.90-3.67), and 1-year mortality (HR 1.64, 95% CI, 1.56-1.71). The cumulative incidence of hospitalization or stroke was greater in the POAF group (HR 1.75, 95% CI, 1.18-2.61). Time-to-event analysis showed frequent AF recurrence within days of surgery, with risk persisting over 1 year. RMST analysis indicated that POAF patients experienced hospitalization or stroke an average of 14.77 days earlier than nPOAF patients during follow-up. New-onset POAF after noncardiac surgery is strongly associated with increased risks of stroke, mortality, and recurrent hospitalization. These findings underscore the importance of early recognition and management, and highlight the need for further research into preventive and therapeutic strategies, including the role of anticoagulation.