| Atrial fibrillation after cardiac surgery: a major morbid event? | |
| | |
MedLine Citation:
|
PMID: 9351718 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: The purpose of the study was to investigate the incidence, predictors, morbidity, and mortality associated with postoperative atrial fibrillation (AF) and its impact on intensive care unit (ICU) and postoperative hospital stay in patients undergoing cardiac surgery in the Department of Veterans Affairs (VA). SUMMARY BACKGROUND DATA: Postoperative AF after open cardiac surgery is rather common. The etiology of this arrhythmia and factors responsible for its genesis are unclear, and its impact on postoperative surgical outcomes remains controversial. The purpose of this special substudy was to elucidate the incidence of postoperative AF and the factors associated with its development, as well as the impact of AF on surgical outcome. METHODS: The study population consisted of 3855 patients who underwent open cardiac surgery between September 1993 and December 1996 at 14 VA Medical Centers. Three hundred twenty-nine additional patients were excluded because of lack of complete data or presence of AF before surgery, and 3794 (98.4%) were male with a mean age of 63.7+/-9.6 years. Operations included coronary artery bypass grafting (CABG) (3126, 81%), CABG + AVR (aortic valve replacement) (228, 5.9%), CABG + MVR (mitral valve replacement) (35, 0.9%), AVR (231, 6%), MVR (41, 1.06%), CABG + others (95, 2.46%), and others (99, 2.5%). The incidence of postoperative AF was 29.6%. Multivariate logistic regression analysis of factors found significant on univariate analysis showed the following predictors of postoperative AF: preoperative patient risk predictors: advancing age (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.48-1.75, p < 0.001), chronic obstructive pulmonary disease (OR 1.37, 95% CI 1.12-1.66, p < 0.001), use of digoxin within 2 weeks before surgery (OR 1.37, 95% CI 1.10-1.70, p < 0.003), low resting pulse rate <80 (OR 1.26, 95% CI 1.06-1.51, p < 0.009), high resting systolic blood pressure >120 (OR 1.19, 95% CI 1.02-1.40, p < 0.026), intraoperative process of care predictors: cardiac venting via right superior pulmonary vein (OR 1.42, 95% CI 1.21-1.67, p < 0.0001), mitral valve repair (OR 2.86, 95% CI 1.72-4.73, p < 0.0001) and replacement (OR 2.33, 95% CI 1.55-3.55, p < 0.0001), no use of topical ice slush (OR 1.29, 95% CI 1.10-1.49, p < 0.0009), and use of inotropic agents for greater than 30 minutes after termination of cardiopulmonary bypass (OR 1.36, 95% CI 1.16-1.59, p < 0.0001). Postoperative median ICU stay (3.6 days AF vs. 2 days no AF, p < 0.001) and hospital stay (10 days AF vs. 7 days no AF, p < 0.001) were higher in AF. Morbid events, hospital mortality, and 6-month mortality were significantly higher in AF (p < 0.001): ICU readmission 13% AF vs. 3.9% no AF, perioperative myocardial infarction 7.41 % AF vs. 3.36% no AF, persistent congestive heart failure 4.57% AF vs. 1.4% no AF, reintubation 10.59% AF vs. 2.47% no AF, stroke 5.26% AF vs. 2.44% no AF, hospital mortality 5.95% AF vs. 2.95% no AF, 6-month mortality 9.36% AF vs. 4.17% no AF. CONCLUSIONS: Atrial fibrillation after cardiac surgery occurs in approximately one third of patients and is associated with an increase in adverse events in all measurable outcomes of care and increases the use of hospital resources and, therefore, the cost of care. Strategies to reduce the incidence of AF after cardiac surgery should favorably affect surgical outcomes and reduce utilization of resources and thus lower cost of care. |
| | |
Authors:
|
G H Almassi; T Schowalter; A C Nicolosi; A Aggarwal; T E Moritz; W G Henderson; R Tarazi; A L Shroyer; G K Sethi; F L Grover; K E Hammermeister |
Related Documents
:
|
10822038 - Atrial fibrillation: nonpharmacologic approaches. 17016418 - Prognostic significance of atrial fibrillation in thrombolysed and non thrombolysed pat... 9737648 - Perspectives and controversies in atrial fibrillation. 12000158 - Neurohormones in mitral stenosis before and after percutaneous balloon mitral valvotomy. 17235108 - Serum nt-probnp concentrations in the early phase do not predict the severity of systol... 3259728 - Coronary reoperations. |
Publication Detail:
|
Type: Journal Article; Multicenter Study; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
|
Title: Annals of surgery Volume: 226 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 1997 Oct |
Date Detail:
|
Created Date: 1997-11-13 Completed Date: 1997-11-13 Revised Date: 2009-11-18 |
Medline Journal Info:
|
Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 501-11; discussion 511-3 Citation Subset: AIM; IM |
Affiliation:
|
Zablocki VA Medical Center and Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee 53226, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Atrial Fibrillation / etiology* Cardiac Surgical Procedures / adverse effects* Coronary Artery Bypass / adverse effects Female Heart Valve Prosthesis Implantation / adverse effects Hospitals, Veterans Humans Incidence Intensive Care Units Length of Stay Logistic Models Male Middle Aged Odds Ratio Risk Factors |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Prevalence of activating K-ras mutations in the evolutionary stages of neoplasia in intraductal papi...
Next Document: Ileal pouch-anal canal anastomosis for familial adenomatous polyposis: early and late results.