Association Between Perioperative Atrial Fibrillation and Long-term Risks of Stroke and Death in Noncardiac Surgery: Systematic Review and Meta-analysis

Abstract

Background: Atrial fibrillation (AF) is frequently reported as a complication of noncardiac surgery. It is unknown whether new-onset perioperative AF is associated with an increased risk of stroke and death beyond the perioperative period. We performed a systematic review and meta-analysis to assess the long-term risks of stroke and mortality associated with new-onset perioperative AF after noncardiac surgery. Methods: MEDLINE and EMBASE were searched from inception to March 2020 for studies reporting on the association between R ESUM E Contexte : La fibrillation atriale (FA) est une arythmie fr equemment attribu ee à une complication d'une chirurgie non cardiaque. On ne sait toutefois pas si l'apparition d'une FA p eriop eratoire est associ ee à un risque accru d'accident vasculaire c er ebral et de d ecès au-delà de la p eriode p eriop eratoire. Nous avons donc proc ed e à un examen et à une m eta-analyse syst ematiques dans le but d' evaluer les risques à long terme d'accident vasculaire c er ebral et de d ecès associ es à l'apparition d'une FA p eriop eratoire à la suite d'une chirurgie non cardiaque.

Frequency and risk factors of atrial fibrillation after acute abdominal surgery: A prospective cohort study

“…A target population of AF screening after acute abdominal major surgery could be patients above 60 years undergoing major surgery where the "hit rate" is high and clinically meaningful. Studies performed in elective noncardiac surgery indicate that POAF is associated with an increased risk of long-term recurrent AF, [39][40][41] thromboembolism, 11,[40][41][42][43][44][45] and mortality. 11,40,43,[45][46][47] These studies could be a rationale for an increasingly ambitious diagnosis of POAF.…”

“…Studies performed in elective noncardiac surgery indicate that POAF is associated with an increased risk of long-term recurrent AF, [39][40][41] thromboembolism, 11,[40][41][42][43][44][45] and mortality. 11,40,43,[45][46][47] These studies could be a rationale for an increasingly ambitious diagnosis of POAF.…”

“…3,4 Data from epidemiological studies of atrial fibrillation (AF) occurring concomitantly to other diseases in the general population and populations undergoing noncardiac surgery have shown a higher risk of copious complications such as stroke and mortality. [5][6][7][8][9][10][11] Limited and heterogeneous prospective studies have investigated POAF within the field of abdominal surgery. 12 A recent review reported a mean 7.6% frequency of POAF in elective abdominal surgery.…”

Risk Factors for New Onset Atrial Fibrillation during Thyroid Gland Surgery

“…The absolute risk of ischaemic stroke or transient ischaemic attack at 5 years for patients with perioperative AF is significant compared with those with no AF and rises to 10.7% [3,5]. Similarly, an increased risk of all-cause death has been reported for patients with AF compared with those with no AF [3,4].…”

“…It is associated with an increase in morbidity and prolonged length of hospital stay, as well as with a higher cost of treatment of these patients [ 2 ]. Complications, especially ischaemic stroke, transient ischaemic attack, and other thromboembolic complications, are more frequent in patients with AF, resulting in higher perioperative mortality [ 3 , 4 ]. The absolute risk of ischaemic stroke or transient ischaemic attack at 5 years for patients with perioperative AF is significant compared with those with no AF and rises to 10.7% [ 3 , 5 ].…”