What is the clinical evidence from this study?

Study design: Cohort. Population: Esophageal cancer (n=583). Intervention: Postoperative atrial fibrillation vs. No postoperative atrial fibrillation. Primary outcome: Long-term all-cause mortality (HR 1.507, 95% CI 1.003-2.266, p=0.049).

May 5, 2016Open Access

Association between Postoperatively Developed Atrial Fibrillation and Long-Term Mortality after Esophagectomy in Esophageal Cancer Patients: An Observational Study

JCJi‐Hyun ChinUlsan College YMYoung‐Jin MoonUlsan College JJJun-Young JoUlsan College

Key Result

Postoperatively developed atrial fibrillation was significantly associated with increased long-term mortality (HR 1.507) in esophageal cancer patients after esophagectomy.

Study Design

Type

Cohort (n=583)

Multicenter

Structured PICO

Does newly developed postoperative atrial fibrillation increase mortality in esophageal cancer patients undergoing esophagectomy?

Population

583 predominantly male patients with esophageal cancer who underwent esophagectomy, free of prior atrial fibrillation, followed for a median of 50.7 months.

Exposure

Newly developed postoperative atrial fibrillation (AF) requiring treatment

Comparator

No postoperative atrial fibrillation

Outcome

All-cause mortality (long-term mortality)hard clinical

Newly developed postoperative atrial fibrillation is a significant predictor of both 1-year and long-term mortality in patients undergoing esophagectomy for esophageal cancer.

Main Result

Hazard Ratio: 1.507 (95% CI 1.003–2.266)

Absolute Event Rate: 46% vs 33.8%

p-value: p=0.049

Limitations

Retrospective observational design with potential unmeasured confounders
Inability to determine exact sequence and causality between postoperative AF and other complications
Lack of data on duration of preoperative medication use
Extreme male predominance (94%) limits generalizability to females
Potential underestimation of AF incidence due to missing asymptomatic cases

Abstract

BACKGROUND: Newly developed atrial fibrillation (AF) in patients who have undergone an esophagectomy increases the incidence of postoperative complications. However, the clinical implications of AF have not been fully elucidated in these patients. This retrospective observational study investigated the predictors for AF and the effect of AF on the mortality in esophageal cancer patients undergoing esophagectomy. METHODS: This study evaluated 583 patients undergoing esophagectomy, from January 2005 to April 2012. AF was defined as newly developed postoperative AF requiring treatment. The risk factors for AF and the association between AF and mortality were evaluated. The long-term mortality was the all-cause mortality, for which the cutoff date was May 31, 2014. RESULTS: AF developed in 63 patients (10.8%). Advanced age (odds ratio OR 1.099, 95% confidence interval CI 1.056-1.144, P < 0.001), preoperative calcium channel blocker (CCB) (OR 2.339, 95% CI 1.143-4.786, P = 0.020), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR 0.206, 95% CI 0.067-0.635, P = 0.006) were associated with the incidence of AF. The Kaplan-Meier curve showed a significantly lower survival rate in the AF group compared to the non-AF group (P = 0.045), during a median follow-up of 50.7 months. The multivariable analysis revealed associations between AF and the 1-year mortality (hazard ratio HR 2.556, 95% CI 1.430-4.570, P = 0.002) and between AF and the long-term mortality (HR 1.507, 95% CI 1.003-2.266, P = 0.049). CONCLUSIONS: In esophageal cancer patients, the advanced age and the preoperative medications (CCB, ACEI or ARB) were associated with the incidence of AF. Furthermore, postoperatively developed AF was associated with mortality in esophageal cancer patients after esophagectomy, suggesting that a close surveillance might be required in patients who showed AF during postoperative period.

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