Key result
Coexistent atrial fibrillation during cardiac surgery hospitalizations was associated with lower inpatient mortality (3.9% vs 5.0%; OR 0.48, 95% CI 0.29-0.80, p<0.001) compared to no AF.
Why the study?
The short-term impact of AF on cardiac surgery hospitalizations had been reported in cohorts of various sizes, but results remained variable.
Does coexistent atrial fibrillation impact inpatient mortality, length of stay, and cost in adult hospitalizations for cardiac surgery?
Cohort (n=1,269,414)
Yes
Does coexistent atrial fibrillation impact inpatient mortality, length of stay, and cost in adult hospitalizations for cardiac surgery?
Odds Ratio: 0.48 (95% CI 0.29–0.8)
Absolute Event Rate: 3.9% vs 5%
p-value: p=<0.001
Coexistent atrial fibrillation in patients undergoing cardiac surgery is paradoxically associated with lower inpatient mortality and stroke prevalence, but higher length of stay and costs.
Should not change perioperative practice; observational association leaves open confounding versus any protective effect of AF.
The short-term impact of atrial fibrillation (AF) on cardiac surgery hospitalizations has been previously reported in cohorts of various sizes, but results have been variable. Using the 2005-2014 National Inpatient Sample, we identified all adult hospitalizations for cardiac surgery using the International Classification of Diseases, Ninth Revision, Clinical Modification as any procedure code and AF as any diagnosis code. We estimated the impact of AF on inpatient mortality, length of stay (LOS), and cost of hospitalization using survey-weighted, multivariable logistic, accelerated failure-time log-normal, and log-transformed linear regressions, respectively. Additionally, we exact-matched AF to non-AF hospitalizations on various confounders for the same outcomes. A total of 1,269,414 hospitalizations were noted for cardiac surgery during the study period. Coexistent AF was found in 44.9% of these hospitalizations. Overall mean age was 65.6 years, 40.9% were female, mean LOS was 11.6 days, and inpatient mortality was 4.5%. Stroke rate was lower in AF hospitalizations (1.8% vs 2.1%, p<0.001). Mortality was lower in the AF (3.9%) versus the non-AF (5%) group (exact-matched OR or emOR=0.48, 95% CI 0.29 to 0.80, p<0.001; 987 matched pairs, n=2423), with similar results after procedural stratification: isolated valve replacement/repair (emOR=0.38, p<0.001), isolated coronary artery bypass graft (CABG) (emOR=0.33, p<0.001), and CABG with valve replacement/repair (emOR=0.55, p<0.001). A 12% increase was seen in LOS in the AF subgroup (exact-matched time ratio=1.12, 95% CI 1.10 to 1.14, p<0.001) among hospitalizations which underwent valve replacement/repair with or without CABG. Hospitalizations for cardiac surgery which had coexistent AF were found to have lower inpatient mortality risk and stroke prevalence but higher LOS and hospitalization costs compared with hospitalizations without AF.
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Agnihotri et al. (2022) conducted a cohort in Cardiac surgery (n=1,269,414). Atrial fibrillation vs. No atrial fibrillation was evaluated on Inpatient mortality (OR 0.48, 95% CI 0.29-0.80, p=<0.001). Coexistent atrial fibrillation during cardiac surgery hospitalizations was associated with lower inpatient mortality (3.9% vs 5.0%; OR 0.48, 95% CI 0.29-0.80, p<0.001) compared to no AF.
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