Incidence and impact of new-onset postoperative arrhythmia after surgery of the lower gastrointestinal tract

Abstract

Postoperative arrhythmias (PAs) are common events and have been widely investigated in cardiothoracic surgery. Within visceral surgery, a recent study revealed a significant occurrence of PA in esophageal resections. In contrast, PA in lower gastrointestinal surgery is rarely investigated and has been rudimentary described in the medical literature. The present work is a retrospective cohort study of 1171 patients who underwent surgery of lower gastrointestinal tract between 2012 and 2018. All included patients were treated and monitored in the intensive care unit (ICU) or intermediate care unit (IMC) after surgery. Follow-up, performed between January and May 2021, was obtained for the patients with PA investigating the possible persistence of PA and complications such as permanent arrhythmia or thromboembolic events after discharge. In total, n = 1171 patients (559 female, 612 male) without any history of prior arrhythmia were analyzed. Overall, PA occurred in n = 56 (4.8%) patients after surgery of the lower GI. The highest incidence of PA was seen in patients undergoing bowel surgery after mesenteric ischaemia (26.92%), followed by cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC; 16.67%). PA was significantly associated with higher age (72 years (IQR 63–78 years) vs. 64 years (IQR 55–73.5 years), p < 0.001) and longer length of stay in the ICU (median 15 days (IQR 5–25 days) vs. median 2 days (IQR 1–5 days), p < 0.001). PA was independently associated with organ failure (OR = 4.62, 95% CI 2.11–10.11, p < 0.001) and higher in-house mortality (OR = 3.37, 95% CI 1.23–9.28, p < 0.001). In median, PA occurred 66.5 h after surgery. In follow-up, 31% of all the patients with PA showed development of permanent arrhythmia. The incidence of PA after lower GI surgery is comparatively low. Its occurrence, however, seems to have severe implications since it is significantly associated with higher rates of organ failure and in-house mortality. Also, compared to the general population, the development of permanent arrhythmia is significantly higher in patients who developed new-onset PA.

Short- and Long-Term Outcomes of Patients with Postoperative Arrhythmia after Liver Surgery

“…Moreover, PA was significantly associated with in-house mortality and severe postoperative complications [1]. These findings were in line with those of a subsequent study of PA after surgery on the lower gastrointestinal tract: While the incidence was distinctively lower, the impact remained severe [2].…”

“…Liver surgery does not have a thoracic component, but the anatomical proximity and the functional dependence between the heart and liver necessitate an analysis of PA after liver surgery. Additionally, PA has often been associated with postoperative complications (e.g., infection, organ failure, mortality) [1,2] that regularly occur after liver surgery.…”

Atrial Fibrillation and Mortality after Gastrointestinal Surgery: Insights from a Systematic Review and Meta-Analysis

“…In 2023, Rühlmann et al also undertook a study with the aim of ascertaining whether postoperative atrial fibrillation reduces the risk of mortality and gastrointestinal surgery. In their research, they discovered a correlation by which lower intestinal tract surgeries increase the risk of atrial fibrillation, which may ultimately result in mortality [ 25 ]. The authors of an observational study provided support for the assertion that atrial fibrillation exhibits the most substantial correlation with 90-day mortality among patients who have undergone gastrointestinal surgery, as indicated by a hazard ratio of 4.4 (2.8–6.8).…”

Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies

“…Specifically, patients undergoing bowel resection for mesenteric ischemia exhibited the highest incidence rate at 26.92%, followed by cytoreductive surgery (CRS) in combination with abdominal thermochemotherapy at 16.67%. Conversely, abdominal perineal proctocolectomy/resection showed an incidence rate of 4.4%, while left hemicolectomy/sigmoid colectomy/anterior rectal resection and Hartmann surgery demonstrated a notably lower incidence rate of POAF at 3.83% ( 15 ). It is worth noting that the true incidence rate of POAF in patients may be underestimated since the majority of included studies relied on POAF reports from databases rather than utilizing continuous ECG monitoring to capture arrhythmias.…”