Key result
Postoperative atrial fibrillation linked to ~130% higher odds of discharge to a rehabilitation facility.
Why the study?
Postoperative atrial fibrillation frequently complicates cardiac surgery, and predicting it can guide interventions to prevent its onset.
What is the incidence of postoperative atrial fibrillation after cardiac surgery, how well do risk scores predict it, and what are its associated in-hospital outcomes?
Cohort (n=1,606)
No
What is the incidence of postoperative atrial fibrillation after cardiac surgery, how well do risk scores predict it, and what are its associated in-hospital outcomes?
Effect estimate: OR 2.30 (95% CI 1.73-3.08)
Postoperative atrial fibrillation occurs in nearly a third of cardiac surgery patients and is associated with increased morbidity, yet current risk scores perform poorly in predicting its onset.
POAF was associated with more rehabilitation discharges after cardiac surgery; this Level 3 finding leaves open causal impact and needs prospective confirmation.
BACKGROUND: Postoperative atrial fibrillation (POAF) frequently complicates cardiac surgery. Predicting POAF can guide interventions to prevent its onset. This study assessed the incidence, risk factors, and related adverse outcomes of POAF after cardiac surgery. METHODS: A cohort of 1,606 patients undergoing cardiac surgery at a tertiary referral center was analyzed. Postoperative AF was defined based on the Society of Thoracic Surgeons' criteria: AF/atrial flutter after operating room exit that either lasted longer than 1 hour or required medical or procedural intervention. Risk factors for POAF were evaluated, and the performance of established risk scores (POAF, HATCH, COM-AF, CHA2DS2-VASc, and Society of Thoracic Surgeons risk scores) in predicting POAF was assessed using discrimination (area under the receiver operator characteristics curve) analysis. The association of POAF with secondary outcomes, including length of hospital stay, ventilator time, and discharge to rehabilitation facilities, was evaluated using adjusted linear and logistic regression models. RESULTS: The incidence of POAF was 32.2% (n = 517). Patients who developed POAF were older, had traditional cardiovascular risk factors and higher Society of Thoracic Surgeons risk scores, and often underwent valve surgery. The POAF risk score demonstrated the highest area under the receiver operator characteristics curve (0.65), but risk scores generally underperformed. Postoperative AF was associated with extended hospital stays, longer ventilator use, and higher likelihood of discharge to rehabilitation facilities (odds ratio, 2.30; 95% CI, 1.73-3.08). CONCLUSION: This study observed a high incidence of POAF following cardiac surgery and its association with increased morbidity and resource utilization. Accurate POAF prediction remains elusive, emphasizing the need for better risk-prediction methods and tailored interventions to diminish the effect of POAF on patient outcomes.
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Segar et al. (2023) conducted a cohort in Postoperative atrial fibrillation after cardiac surgery (n=1,606). Postoperative atrial fibrillation (exposure) vs. No postoperative atrial fibrillation was evaluated on Discharge to rehabilitation facilities (OR 2.30, 95% CI 1.73-3.08). Postoperative atrial fibrillation occurred in 32.2% of cardiac surgery patients and was associated with a higher likelihood of discharge to rehabilitation facilities (OR 2.30; 95% CI 1.73-3.08).
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