New-Onset POAF After Craniotomy: Impact on Neurological Outcome, ICU Utilization, and Mortality

Area of Science:

• Neurosurgery
• Cardiology
• Critical Care Medicine

Background:

• Atrial fibrillation is a common perioperative arrhythmia.
• Its impact on neurosurgical patients is poorly understood.
• Neurosurgical patients may have increased vulnerability to arrhythmias.

Purpose of the Study:

• To determine if postoperative atrial fibrillation (POAF) signifies a higher-risk profile in neurosurgical patients.
• To assess the association of POAF with complications, resource use, and mortality.
• To compare outcomes in patients with POAF versus those in sinus rhythm (SR).

Main Methods:

• Single-center retrospective cohort study (October 2020-April 2025).
• Included 171 neurosurgical patients with pre- and post-procedure ECGs and no prior arrhythmias.
• Compared outcomes between POAF and SR groups using statistical tests and odds ratios.

Main Results:

• Patients with POAF were older, had more comorbidities, and underwent more invasive/emergency procedures.
• POAF was associated with higher postoperative complications and longer ICU/hospital stays.
• POAF correlated with reduced home discharge likelihood and increased short-term mortality.

Conclusions:

• Newly detected POAF identifies a higher-risk neurosurgical patient profile.
• POAF clusters with comorbidities, urgent procedures, complications, and adverse outcomes.
• Further evaluation of rhythm surveillance and perioperative management in high-risk neurosurgical patients is warranted.