Efficacy and safety of perioperative colchicine for prevention of postoperative atrial fibrillation after thoracic cardiac and non-cardiac surgery: an updated systematic review and meta-analysis

Background Given the anti-inflammatory properties of colchicine, its role in preventing Postoperative atrial fibrillation (POAF) remains unclear. This study aimed to evaluate the efficacy and safety of perioperative colchicine in patients undergoing cardiac and non-cardiac surgery. Methods A systematic search of PubMed, Scopus, and Web of Science was performed up to 2 May 2026. Randomized controlled trials (RCTs) and comparative observational studies with adjusted analyses (e.g., propensity-score matched cohorts) comparing colchicine with standard care or placebo were eligible for inclusion. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup, sensitivity analysis, publication bias, and meta-regression analyses were performed. Results Thirteen studies involving 5,529 patients (49.79% receiving colchicine) were included. The colchicine group demonstrated a non-significant reduction in the overall risk of POAF compared with the control group (RR: 0.80, 95% CI: 0.63–1.02; p = 0.07). Although patients undergoing coronary artery bypass grafting (CABG) experienced a significant reduction in POAF risk (RR: 0.72, 95% CI: 0.55–0.95; p = 0.02), no significant effect was observed in cardiac non-CABG surgeries (RR: 1.24, 95% CI: 0.77–2.02; p = 0.38) or non-cardiac surgeries (RR: 0.90, 95% CI: 0.50–1.63; p = 0.73). Colchicine did not significantly affect all-cause mortality, hospital length of stay, postoperative myocardial infarction, stroke or transient ischemic attack, post-pericardiotomy syndrome, or myocardial injury after non-cardiac surgery compared with the control group (all p > 0.05). Colchicine was associated with a significantly higher risk of discontinuation due to adverse events (RR: 1.33, 95% CI: 1.14–1.54; p < 0.01), serious adverse events (RR: 1.63, 95% CI: 1.02–2.59; p = 0.04), gastrointestinal complications (RR: 2.30, 95% CI: 1.43–3.69; p < 0.01), and diarrhea (RR: 3.24, 95% CI: 2.48–4.24; p < 0.01). These safety signals were driven primarily by gastrointestinal intolerance and treatment discontinuation; the serious-adverse-event estimate was based on relatively sparse events and should be interpreted cautiously. Conclusions Although the primary analysis did not demonstrate a statistically significant reduction in POAF with perioperative colchicine, exploratory subgroup analysis suggested a significant reduction in POAF among patients undergoing CABG. However, this finding should be interpreted cautiously because the between-group difference across surgery types was not statistically significant (p = 0.15). Colchicine was associated with increased gastrointestinal adverse events, diarrhea, and treatment discontinuation; the observed serious-adverse-event signal should be interpreted cautiously because of sparse events. Any potential benefit in the CABG-containing cardiac subgroup should therefore be weighed against the treatment’s tolerability profile.