Frequency and risk factors of atrial fibrillation after acute abdominal surgery: A prospective cohort study.
Holter
emergency surgery
postoperative complications
risk assessment
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
17 Nov 2023
17 Nov 2023
Historique:
revised:
01
11
2023
received:
16
06
2023
accepted:
05
11
2023
medline:
17
11
2023
pubmed:
17
11
2023
entrez:
17
11
2023
Statut:
aheadofprint
Résumé
Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of clinically recognized POAF and associated complications, along with their risk factors. This study was a prospective, single-center cohort study of unselected adult patients referred for acute abdominal surgery during a 3-month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in-hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri- and postoperative continuous cardiac rhythm monitoring. In total, 450 patients were enrolled. Clinically recognized in-hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in-hospital complications (POAF group 45.5% vs. non-POAF group 8.6%, p < .001) and in-hospital mortality (POAF group 13.6% vs. non-POAF group 3.0%, p = .043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF. In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in-hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of clinically recognized POAF and associated complications, along with their risk factors.
METHODS
METHODS
This study was a prospective, single-center cohort study of unselected adult patients referred for acute abdominal surgery during a 3-month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in-hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri- and postoperative continuous cardiac rhythm monitoring.
RESULTS
RESULTS
In total, 450 patients were enrolled. Clinically recognized in-hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in-hospital complications (POAF group 45.5% vs. non-POAF group 8.6%, p < .001) and in-hospital mortality (POAF group 13.6% vs. non-POAF group 3.0%, p = .043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF.
CONCLUSIONS
CONCLUSIONS
In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in-hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Danmarks Frie Forskningsfond
Organisme : IMK Almene Fond
ID : 30206-093
Organisme : Novo Nordisk Fonden
ID : NNF18OC0052882
Informations de copyright
© 2023 Acta Anaesthesiologica Scandinavica Foundation.
Références
Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12:1360-1420.
Frendl G, Sodickson AC, Chung MK, et al. 2014 AATS guidelines for the prevention and management of peri-operative atrial fibrillation and flutter (POAF) for thoracic surgical procedures. J Thorac Cardiovasc Surg. 2014;148:e153-e193.
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation. 2019;140:e125-e151.
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42:373-498.
Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med. 1998;129:279-285.
Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839-1847.
Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J. 2012;164:918-924.
Lubitz SA, Yin X, Rienstra M, et al. Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation. 2015;131:1648-1655.
Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386:154-162.
Koshy AN, Hamilton G, Theuerle J, et al. Postoperative atrial fibrillation following noncardiac surgery increases risk of stroke. Am J Med. 2019;133:311-322.
Huynh JT, Healey JS, Um KJ, et al. Association between perioperative atrial fibrillation and long-term risks of stroke and death in noncardiac surgery: systematic review and meta-analysis. CJC Open. 2021;3:666-674.
Chebbout R, Heywood EG, Drake TM, et al. A systematic review of the incidence of and risk factors for postoperative atrial fibrillation following general surgery. Anaesthesia. 2018;73:490-498.
Heywood EG, Drake TM, Bradburn M, Lee J, Wilson MJ, Lee MJ. Atrial fibrillation after gastrointestinal surgery: incidence and associated risk factors. J Surg Res. 2019;238:23-28.
Royal College of Physicians. National Early Warning Score (NEWS): Standardising the Assessment of Acute Illness Severity in the NHS. Report of a Working Party. RCP; 2012.
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297. doi:10.1371/journal.pmed.0040297
Hegelund ER, Kjerpeseth LJ, Mortensen LH, et al. Prevalence and incidence rates of atrial fibrillation in Denmark. Clin Epidemiol. 2022;14:1193-1204.
Taha A, Nielsen SJ, Bergfeldt L, et al. New-onset atrial fibrillation after coronary artery bypass grafting and long-term outcome: a population-based nationwide study from the SWEDEHEART registry. J Am Heart Assoc. 2021;10:1-9.
Leibowitz D, Abitbol C, Alcalai R, Rivkin G, Kandel L. Perioperative atrial fibrillation is associated with increased one-year mortality in elderly patients after repair of hip fracture. Int J Cardiol. 2017;227:58-60.
Vaporciyan AA, Correa AM, Rice DC, et al. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004;127:779-786.
Andrade JG, Deyell MW, Lee AYK, Macle L. Sex differences in atrial fibrillation. Can J Cardiol. 2018;34:429-436.
Amar D, Zhang H, Leung DHY, Roistacher N, Kadish AH. Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology. 2002;96:352-356.
Todorov H, Janssen I, Honndorf S, et al. Clinical significance and risk factors for new onset and recurring atrial fibrillation following cardiac surgery - a retrospective data analysis. BMC Anesthesiol. 2017;17:1-10.
Guichard J, Nattel S. Atrial cardiomyopathy. J Am Coll Cardiol. 2017;70:756-765.
Madsen CV, Jørgensen LN, Leerhøy B, et al. Predictors of postoperative atrial fibrillation after abdominal surgery and insights from other surgery types. Res Rep Clin Cardiol. 2020;11:31-38.
Lu R, Ma N, Jiang Z, Mei J. Hemodynamic parameters predict the risk of atrial fibrillation after cardiac surgery in adults. Clin Cardiol. 2017;40:1100-1104.
Anderson EJ, Efird JT, Kiser AC, et al. Plasma catecholamine levels on the morning of surgery predict post-operative atrial fibrillation. J Am Coll Cardiol. 2017;3:1456-1465.
Wu JHY, Marchioli R, Silletta MG, et al. Oxidative stress biomarkers and incidence of postoperative atrial fibrillation in the omega-3 fatty acids for prevention of postoperative atrial fibrillation (OPERA) trial. J Am Heart Assoc. 2015;4:1-8.
Jacob KA, Nathoe HM, Dieleman JM, Van Osch D, Kluin J, van Dijk D. Inflammation in new-onset atrial fibrillation after cardiac surgery: a systematic review. Eur J Clin Invest. 2014;44:402-428.
Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015;154:13-20.
Rettig TCD, Verwijmeren L, Dijkstra IM, Boerma D, Van De Garde EMW, Noordzij PG. Postoperative interleukin-6 level and early detection of complications after elective major abdominal surgery. Ann Surg. 2016;263:1207-1212.
Kazaure HS, Roman SA, Tyler D, Sosa JA. The significance of atrial fibrillation in patients aged ≥55 years undergoing abdominal surgery. World J Surg. 2015;39:113-120.
Pearse RM, Harrison DA, MacDonald N, et al. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery a randomized clinical trial and systematic review. JAMA. 2014;311:2181-2190.
Hirsh BJ, Copeland-Halperin RS, Halperin JL. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism mechanistic links and clinical inferences. J Am Coll Cardiol. 2015;65:2239-2251.
Aguilar M, Dobrev D, Nattel S. Postoperative atrial fibrillation features, mechanisms, and clinical management. Card Electrophysiol Clin. 2021;13:123-132.
Jokinen JDV, Carlsson CJ, Rasmussen SM, et al. Wireless single-lead ECG monitoring to detect new-onset postoperative atrial fibrillation in patients after major noncardiac surgery: a prospective observational study. Anesth Analg. 2022;135:100-109.
Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366:120-129.
Mahajan R, Perera T, Elliott AD, et al. Subclinical device-detected atrial fibrillation and stroke risk: a systematic review and meta-analysis. Eur Heart J. 2018;39:1407-1415.
Gibbs H, Freedman B, Rosenqvist M, et al. Clinical outcomes in asymptomatic and symptomatic atrial fibrillation presentations in GARFIELD-AF: implications for AF screening. Am J Med. 2021;134:893-901.
Higuchi S, Kabeya Y, Matsushita K, et al. Perioperative atrial fibrillation in noncardiac surgeries for malignancies and one-year recurrence. Can J Cardiol. 2019;35:1449-1456.
Siontis KC, Gersh BJ, Weston SA, et al. Association of new-onset atrial fibrillation after noncardiac surgery with subsequent stroke and transient ischemic attack. Jama. 2020;324:871-878.
Hyun J, Soo Cho M, Nam G-B, et al. Natural course of new-onset postoperative atrial fibrillation after noncardiac surgery. J Am Heart Assoc. 2021;10:e018548.
Butt JH, Olesen JB, Havers-borgersen E, et al. Risk of thromboembolism associated with atrial fibrillation following noncardiac surgery. J Am Coll Cardiol. 2018;72:2027-2036.
Alturki A, Marafi M, Proietti R, et al. Major adverse cardiovascular events associated with postoperative atrial fibrillation after noncardiac surgery: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2020;13:71-80.
Koshy AN, Enyati A, Weinberg L, et al. Postoperative atrial fibrillation and long-term risk of stroke in patients undergoing liver transplantation. Stroke. 2021;52:111-120.
Lin M-HH, Kamel H, Singer DE, Wu YL, Lee M, Ovbiagele B. Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality - a meta-analysis. Stroke. 2019;50:1364-1371.
Chin J-H, Moon Y-J, Jo J-Y, et al. Association between postoperatively developed atrial fibrillation and long-term mortality after esophagectomy in esophageal cancer patients: an observational study. PloS one. 2016;11:e0154931.
Kothari AN, Halandras PM, Drescher M, et al. Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk. J Vasc Surg. 2017;63:1240-1247.