Why the study?
The relationship between the preoperative triglyceride-glucose index and postoperative atrial fibrillation after esophagectomy, especially in patients without diabetes mellitus, remained unclear.
A higher preoperative triglyceride-glucose (TyG) index is independently associated with an increased risk of postoperative atrial fibrillation following esophagectomy, including in non-diabetic patients.
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May support preoperative TyG for POAF risk stratification post-esophagectomy; hypothesis-generating and needs prospective validation.
Background Postoperative atrial fibrillation (POAF) is common after esophagectomy. The triglyceride-glucose (TyG) index is an accessible cardiometabolic marker derived from fasting triglyceride and glucose levels, but its relationship with POAF after esophagectomy, especially in patients without diabetes mellitus, remains unclear. We evaluated the association between preoperative TyG and POAF and assessed whether TyG added information beyond selected clinical risk factors. Methods This single-center retrospective cohort study screened consecutive adults who underwent curative esophagectomy for histologically confirmed esophageal squamous cell carcinoma between January 2022 and April 2026. Patients receiving preoperative neoadjuvant therapy were excluded. TyG was calculated from preoperative fasting triglyceride and glucose values. The primary outcome was new-onset POAF within 7 postoperative days. Reduced multivariable logistic models were constructed according to event-per-variable considerations. Bayesian logistic regression, restricted cubic spline analysis, ROC analysis, bootstrap internal validation, calibration assessment, and incremental value analyses were performed. A sensitivity analysis was conducted in patients without diabetes. Results Among 554 patients, 76 developed POAF. In the reduced model adjusted for age, sex, diabetes mellitus, and left atrial diameter, higher TyG was associated with increased odds of POAF (OR 4.02, 95% CI 1.90–8.48; P < 0.001). Bayesian analysis was consistent (posterior OR 3.31, 95% credible interval 1.64–6.70). Adding TyG to the baseline clinical model increased apparent AUC from 0.667 to 0.716 and optimism-corrected AUC from 0.647 to 0.694; continuous NRI and IDI were 0.441 and 0.024, respectively. Spline analysis showed a positive overall association without statistically significant non-linearity. In the non-diabetic subgroup ( n = 489), TyG remained associated with POAF (adjusted OR 3.65, 95% CI 1.66–8.02; P = 0.001), with consistent Bayesian and validation findings. Conclusion Higher preoperative TyG was associated with POAF after esophagectomy, including among patients without diabetes. TyG provided modest incremental predictive information beyond selected clinical factors, but these exploratory findings require external validation before clinical thresholds or TyG-guided interventions can be recommended.
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Gao et al. (2026) studied this question.
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