Postoperative Atrial Fibrillation: Evaluation of its Economic Impact on the Costs of Cardiac Surgery

Abstract

Objective The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. Methods We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. Results The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs . US$ 8,856 [± 1,782], respectively, for each patient; P =0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs . US$ 1,238 [± 429]; P =0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF ( P =0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs . 1.6, respectively; P =0.91) or direct costs (US$ 1,127 vs . US$ 1,063, respectively; P =0.56) between POAF and non-POAF groups. Conclusion POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

The Validation of the ATRIA and CHA2DS2-Vasc Scores in Predicting Atrial Fibrillation after Coronary Artery Bypass Surgery

“…Additionally, the present study showed that older age, male gender, drainage amount, pumping time, and ALT levels were associated with POAF. The results corroborated with the previous studies [ 1 , 6 , 9 , 16 , 19 , 21 ] . Age is the most common risk factor of POAF because of occurred myocardial fiber loss, fibrosis, and collagen deposition [ 22 ] .…”

“…POAF is a serious complication of CABG and is associated with worse clinical outcomes such as prolonged length of hospital stay, rising costs, and increased short- and long-term morbidity and mortality [ 16 ] . Several guidelines recommended suggestions for prophylaxis against POAF [ 17 - 19 ] .…”

Cost-Effectiveness Analysis of Landiolol, an Ultrashort-Acting Beta-Blocker, for Prevention of Postoperative Atrial Fibrillation for the Germany Health Care System

“…The increase of approximately $2,000 (1,119 €) was attributable to postoperative costs ($3,103 v $1,238 or 2,805 € v 1,119 €; p = 0.0001) for patients with or without POAF. 48 The following limitations should be considered when interpreting the results of the present analysis. First, the available clinical trials were conducted in Japan, and the recruited patients were, to a large extent, males.…”

Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery: Prospective Observational Study

“…Postoperative atrial fibrillation (POAF) is one of the most important complications after cardiac surgery, occurring in 10%-65% of patients, depending on their risk profile and surgery type [ 1 - 3 ]. The burden of this complication on health care and the economy is significant, as it leads to elevated stroke risk, higher postoperative mortality, longer hospitalization, and an increase in medical costs [ 3 - 5 ]. AF and other arrhythmias typically occur early after surgery, with the incidence of AF peaking on the second to third postoperative day, correlating with the inflammatory peak [ 2 , 6 , 7 ].…”