Key result
A novel amiodarone order set reduced postoperative atrial fibrillation after anatomic lung resection, whereas wedge resection without prophylaxis had a 0.4% incidence; age ≥65 was an independent risk factor (OR 5.41; 95% CI 1.47-19.85).
Why the study?
It was unclear whether non-anatomic wedge resection warrants prophylaxis for post-operative atrial fibrillation, as previously published rates vary widely.
Does an amiodarone order set reduce postoperative atrial fibrillation incidence in patients undergoing lung resection?
Cohort
Does an amiodarone order set reduce postoperative atrial fibrillation incidence in patients undergoing lung resection?
Amiodarone prophylaxis may be beneficial after anatomic lung resection in older patients, but POAF is too rare after wedge resection to justify routine chemoprophylaxis.
Answers are grounded in this paper and cite their sources.
POAF rates after wedge resection without prophylaxis need clarification; leaves open whether amiodarone prophylaxis should extend beyond anatomic resections.
BACKGROUND: Studies have demonstrated that chemoprophylaxis following anatomic lung resection can reduce post-operative atrial fibrillation (POAF). However, it is unclear if non-anatomic wedge resection warrants prophylaxis, as previously published rates vary widely. The primary goal of this study was to assess an institutional rate of POAF following anatomic resections with implementation of a novel amiodarone administration regimen compared to wedge resections without prophylaxis. METHODS: We performed a retrospective cohort study of a prospectively maintained database and compared anatomic and wedge lung resection patients from 1/2015 to 4/2018. During the study period, a previously unpublished amiodarone order set consisting of a 300 mg IV bolus followed by 400 mg tablets TID ×3 days was administered to anatomic resection patients ≥65 who met criteria. Wedge resection patients were not intended to receive amiodarone prophylaxis. The primary outcome was POAF incidence. Risk factors for developing POAF were assessed. RESULTS: 20.3%, P<0.001). A single wedge resection patient (0.4%) developed POAF. On multivariable analysis, the only independent POAF risk factor was age ≥65 (OR: 5.41, 95% CI: 1.47-19.85). CONCLUSIONS: Administration of our novel amiodarone order set reduces POAF after anatomic resection; however, POAF following wedge resection is too rare to warrant chemoprophylaxis.
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Phillips et al. (2020) conducted a cohort in Postoperative atrial fibrillation (POAF). Amiodarone order set vs. Wedge resections without prophylaxis was evaluated on POAF incidence (OR 5.41, 95% CI 1.47-19.85, p=<0.001). A novel amiodarone order set reduced postoperative atrial fibrillation after anatomic lung resection, whereas wedge resection without prophylaxis had a 0.4% incidence; age ≥65 was an independent risk factor (OR 5.41; 95% CI 1.47-19.85).
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