New-onset postoperative atrial fibrillation is associated with perioperative inflammatory response and longer hospital stay after robotic-assisted pulmonary lobectomy

Atrial fibrillation is a common arrhythmia previously linked to systemic inflammation, which has been correlated with leukocyte and prealbumin levels. We sought to identify predictors of postoperative atrial fibrillation (POAF) following robotic-assisted pulmonary lobectomy. This retrospective cohort study included 709 consecutive patients who underwent robotic-assisted lobectomy by one surgeon over 10.7 years. We compared demographics, preoperative comorbidities, perioperative leukocyte, prealbumin levels, complications, chest tube (CT) duration, and hospital length of stay (LOS) using Student's t-test, Chi-square (or Fisher's exact) test, or Wilcoxon rank sums test, with significance at p ≤ 0.05. Multivariable analysis investigated predictors of POAF, CT duration, hospital LOS, and overall survival (OS). Kaplan-Meier analysis estimated OS with 95% confidence intervals. Preoperative atrial fibrillation or chronic steroid or immunosuppressant use excluded 131 patients, and 578 remaining patients were classified as POAF (n=76) or No POAF (n=502). Patients with new-onset POAF were older and had higher incidences of preoperative hypertension and hyperlipidemia, intraoperative complications, and postoperative anemia. The lowest postoperative prealbumin levels were reduced, and peak postoperative leukocyte counts were elevated in POAF patients. Multivariable analysis identified that patients with POAF had longer hospital LOS and lower postoperative prealbumin as factors that independently predict both POAF and increased hospital LOS. New-onset POAF patients had a substantial perioperative inflammatory burden characterized by preoperative hypertension, postoperative leukocytosis, and decreased prealbumin and had prolonged hospital LOS compared with patients without POAF. Postoperative leukocyte and prealbumin levels should be monitored, as these pro-inflammatory markers may forecast POAF.