What does this research mean for the field?

Preoperative atrial fibrillation is independently associated with a higher risk of overall mortality after cardiac surgery, though concomitant Cox-maze surgery may improve survival in these patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 13, 2022Journal of Chest SurgeryOpen Access

Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac surgery (n=1022). Intervention: Preoperative Atrial Fibrillation vs. No preoperative Atrial Fibrillation. Primary outcome: Overall mortality (HR 1.435, 95% CI 1.263-2.107, p=0.034).

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Key result

Preoperative atrial fibrillation was independently associated with a higher risk of overall mortality (HR 1.435) after cardiac surgery compared to patients without preoperative atrial fibrillation.

Why the study?

Because of the increased prevalence of atrial fibrillation in patients undergoing cardiac surgery, assessing its effect on postsurgical outcomes is important.

Does preoperative atrial fibrillation increase mortality in adult patients undergoing cardiac surgery, and does concomitant Cox-maze surgery improve survival in these patients?

Population

1,022 patients undergoing cardiac surgery in Korea

Comparison

Preoperative Afib vs no preoperative Afib

Design

Retrospective cohort study

Authors

HKHyo‐Hyun KimNational Health Insurance Service JKJi-Hong Kim SLSak LeeGeorgia State University

Discussion

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Implication

Preoperative AF signals higher post-cardiac surgery mortality; hypothesis-generating for Cox-maze benefit, pending randomized confirmation.

Study Design

Type

Cohort (n=1,022)

Structured PICO

Does preoperative atrial fibrillation increase mortality in adult patients undergoing cardiac surgery, and does concomitant Cox-maze surgery improve survival in these patients?

Population

1,022 adult patients (≥18 years) who underwent cardiac surgery (coronary artery bypass, heart valve surgery, or aorta surgery) identified from a randomized 1,000,000-patient national health claims database cohort. Excluded: patients treated with isolated surgical Afib ablation (n=15). The cohort included 190 patients (18.6%) with preoperative atrial fibrillation and 832 patients (81.4%) without.

Intervention

Preoperative atrial fibrillation (exposure). A subgroup analysis evaluated the addition of concomitant Cox-maze surgery.

Comparator

No preoperative atrial fibrillation. For the subgroup analysis, the comparator was no concomitant Cox-maze surgery.

Outcome

Overall mortality after cardiac surgeryhard clinical

Main Result

Effect estimate: HR 1.435 (95% CI 1.263-2.107)

p-value: p=0.034

Preoperative atrial fibrillation is independently associated with worse long-term survival after cardiac surgery, but performing a concomitant Cox-maze procedure may significantly improve mortality outcomes.

Limitations

Did not include all patients undergoing cardiac surgery during the study period
Paucity of information on surgeon and hospital characteristics
NHIS data are composed of ICD-10 codes and a basic physical examination database, limiting detailed patient information
Did not include information about the success of the Cox-maze surgery
Not all patients undergoing cardiac surgery during the study period were included, which may limit generalizability.
Paucity of information on surgeon and hospital characteristics in the NHIS database.
Potential selection bias, as maze procedures might have been selectively performed in low-risk patients with shorter disease duration.
Reliance on ICD-10 codes and basic physical examination database, with mortality estimated by loss of insurance status.
Lack of information regarding the success of the Cox-maze surgery and postoperative rhythm status.

Cite This Study

Kim et al. (2022) conducted a cohort in Cardiac surgery (n=1,022). Preoperative Atrial Fibrillation vs. No preoperative Atrial Fibrillation was evaluated on Overall mortality (HR 1.435, 95% CI 1.263-2.107, p=0.034). Preoperative atrial fibrillation was independently associated with a higher risk of overall mortality (HR 1.435) after cardiac surgery compared to patients without preoperative atrial fibrillation.

synapsesocial.com/papers/6a1c1f2e26cb5670aa9d6729 https://doi.org/10.5090/jcs.21.146

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Implication

Preoperative AF signals higher post-cardiac surgery mortality; hypothesis-generating for Cox-maze benefit, pending randomized confirmation.

Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider