Prevalence and risk factors for postoperative atrial fibrillation following pulmonary resection: a systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Postoperative atrial fibrillation (POAF) following pulmonary resection (n=25238). Intervention: Pulmonary resection (exposure to various risk factors) vs. Patients not exposed to the specific risk factors. Primary outcome: Occurrence of new-onset POAF within 30 days after surgery (OR 15.79, 95% CI 4.69-53.13, p=<0.001).

Yuping Yang; Guoqiang Zhong

doi:10.1186/s13019-026-04093-x

April 18, 2026Journal of Cardiothoracic SurgeryOpen Access

Prevalence and risk factors for postoperative atrial fibrillation following pulmonary resection: a systematic review and meta-analysis

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Key result

Pre-existing atrial fibrillation was identified as the strongest predictor for postoperative atrial fibrillation following pulmonary resection, increasing the risk by nearly 16-fold (OR 15.79).

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Why the study?

Risk factors for postoperative atrial fibrillation in patients undergoing pulmonary resection remained to be integrated and clarified across multiple sources.

Do specific patient and surgical risk factors increase the risk of postoperative atrial fibrillation in adult patients undergoing pulmonary resection?

Key Points

To determine the prevalence of and independent risk factors for postoperative atrial fibrillation (POAF) following pulmonary resection (PR).
Systematic search of English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, VIP, Sinomed) through September 25, 2025.
Included 18 observational studies using multivariate logistic regression involving 25,238 patients undergoing PR, extracting pooled odds ratios (OR) with 95% confidence intervals (CI) using STATA 15.0 per PRISMA guidelines.
POAF occurred in 1,967 of 25,238 patients, establishing a pooled prevalence of 7.79%.
Pre-existing atrial fibrillation was the strongest predictor of POAF (OR = 15.79, 95% CI: 4.69–53.13, p < 0.001), followed by history of hyperthyroidism (OR = 5.67, 95% CI: 1.97–16.32, p < 0.001) and pneumonectomy (OR = 4.33, 95% CI: 2.12–8.84, p < 0.001).
Other significant risk factors included age ≥ 65 years (OR = 2.92, 95% CI: 2.02–4.23, p < 0.001), red blood cell transfusion (OR = 2.78, 95% CI: 2.22–3.47, p < 0.001), lobectomy (OR = 2.68, 95% CI: 1.05–6.81, p = 0.039), lymph node dissection (OR = 2.18, 95% CI: 1.12–4.24, p = 0.021), male sex (OR = 1.93, 95% CI: 1.46–2.56, p < 0.001), thoracotomy (OR = 1.71, 95% CI: 1.40–2.09, p < 0.001), and hypertension (OR = 1.34, 95% CI: 1.14–1.57, p < 0.001), whereas VATS was not significantly associated (OR = 1.02, 95% CI: 0.29–3.61, p = 0.97).

Study Design

Type

Meta-Analysis (n=25,238)

Structured PICO

Do specific patient and surgical risk factors increase the risk of postoperative atrial fibrillation in adult patients undergoing pulmonary resection?

P

Population

25,238 adult patients (mean age 69.04 years) undergoing pulmonary resection across 18 observational studies.

I

Intervention

Exposure to patient-related and surgery-related risk factors (including age ≥65, male sex, hypertension, hyperthyroidism, pre-existing AF, thoracotomy, lobectomy, pneumonectomy, lymph node dissection, red blood cell transfusion, and longer operative time).

C

Comparator

Patients not exposed to the specific risk factors under investigation (e.g., younger patients, females, patients undergoing sublobar resection without lymph node dissection).

O

Outcome

Occurrence of new-onset postoperative atrial fibrillation (POAF) within 30 days after surgery.hard clinical

Main Result

Effect estimate: OR 15.79 (95% CI 4.69-53.13)

p-value: p=<0.001

Pre-existing atrial fibrillation, history of hyperthyroidism, and extensive surgical resections (pneumonectomy) are the strongest independent predictors of postoperative atrial fibrillation following pulmonary resection.

Limitations

Significant heterogeneity was observed among studies for several risk factors (e.g., age, gender, lymph node dissection, lobectomy, operative time).
Did not conduct a systematic search of grey literature sources.
The conclusion regarding VATS is based on only two studies and is accompanied by considerable heterogeneity.
Individual studies are often limited by sample size and statistical power.
Lack of data on preoperative management (anticoagulation or rhythm/rate control medications) for pre-existing AF
Lack of stratified data based on AF type (e.g., paroxysmal vs. persistent) or AF burden
Operational definition of POAF conflates recurrence with de novo onset
High heterogeneity in some analyses (e.g., VATS, age, operative time)

Implication

May warrant intensified POAF surveillance after pulmonary resection in older males with pre-existing AF; reinforces these as key independent risk factors.**[[1]](https://link.springer.com/article/10.

Abstract

This study aimed to perform a meta-analysis integrating multiple sources to investigate risk factors for postoperative atrial fibrillation (POAF) in patients undergoing pulmonary resection (PR). We searched English databases (PubMed, Cochrane Library, Embase, Web of Science (WOS)) and Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, Sinomed) up to September 25, 2025. Observational studies utilizing multivariate logistic regression to analyze the prevalence and risk factors of atrial fibrillation (AF) following PR were selected. Meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted, and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using STATA 15.0. Eighteen studies involving 25,238 patients were included, among whom 1,967 developed POAF, yielding a prevalence of 7.79%. Meta-analysis revealed significant associations between POAF and the following risk factors: Age (OR = 1.04, 95% CI: 1.01–1.06, p = 0.011), Age ≥ 65 years (OR = 2.92, 95% CI: 2.02–4.23, p < 0.001), Male (OR = 1.93, 95% CI: 1.46–2.56, p < 0.001), Hypertension (OR = 1.34, 95% CI: 1.14–1.57, p < 0.001), Lymph node dissection (OR = 2.18, 95% CI: 1.12–4.24, p = 0.021), Thoracotomy (OR = 1.71, 95% CI: 1.40–2.09, p < 0.001), Lobectomy (OR = 2.68, 95% CI: 1.05–6.81, p = 0.039), Pneumonectomy (OR = 4.33, 95% CI: 2.12–8.84, p < 0.001), Operative time (minutes) (OR = 1.05, 95% CI: 1.01–1.09, p = 0.026), History of hyperthyroidism (OR = 5.67, 95% CI: 1.97–16.32, p < 0.001), Pre-existing atrial fibrillation (Pre-existing AF) (OR = 15.79, 95% CI: 4.69–53.13, p < 0.001), Red blood cell transfusion (OR = 2.78, 95% CI: 2.22–3.47, p < 0.001). No significant association was found with video-assisted thoracoscopic surgery (VATS) (OR = 1.02, 95% CI: 0.29–3.61, p = 0.97). This study suggests that POAF following PR is associated with multiple patient- and surgery-related risk factors, many of which are identifiable preoperatively. Pre-existing AF was identified as the strongest predictor among the factors analyzed. These findings support the rationale for integrating preoperative risk assessment into the planning of individualized postoperative monitoring and prevention strategies, which may help improve clinical outcomes.

Discussion

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Cite This Study

Yang et al. (2026) conducted a meta-analysis in Postoperative atrial fibrillation (POAF) following pulmonary resection (n=25,238). Pulmonary resection (exposure to various risk factors) vs. Patients not exposed to the specific risk factors was evaluated on Occurrence of new-onset POAF within 30 days after surgery (OR 15.79, 95% CI 4.69-53.13, p=<0.001). Pre-existing atrial fibrillation was identified as the strongest predictor for postoperative atrial fibrillation following pulmonary resection, increasing the risk by nearly 16-fold (OR 15.79).

synapsesocial.com/papers/69e7138bcb99343efc98cfa7 https://doi.org/10.1186/s13019-026-04093-x

Topics

Atrial fibrillation

Persistent AF management

Anticoagulation in AF

AF ablation outcomes

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Prevalence and risk factors for postoperative atrial fibrillation following pulmonary resection: a systematic review and meta-analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Prevalence and risk factors for postoperative atrial fibrillation following pulmonary resection: a systematic review and meta-analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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