Incidence, Associated Risk Factors, and Outcomes of Postoperative Arrhythmia After Upper Gastrointestinal Surgery

Rühlmann, Felix; Tichelbäcker, Tobias; Mackert, Alma Franziska; Engelhardt, Deborah; Leha, Andreas; Bernhardt, Markus; Ghadimi, Michael; Perl, Thorsten; Azizian, Azadeh; Gaedcke, Jochen

doi:10.1001/jamanetworkopen.2022.23225

Cited by 8 publications

(13 citation statements)

References 30 publications

(80 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In upper GI surgery, specifically in oesophageal resection with an incidence between 16.5 and 23.1% 4 – 7 , mechanical manipulation of the myocardium or pericardium is discussed as an important factor. Our previous analysis which investigated the occurrence of PA in patients who underwent upper GI surgery revealed a general incidence of 8.3% 10 . In lower GI surgery different factors are supposed to trigger PA such as an increase in hormonal and sympathetic activity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Rühlmann¹,

Hedicke²,

Engelhardt³

et al. 2023

Sci Rep

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In a recent study of our group we evaluated the impact of PA in patients after upper GI surgery including not only esophagectomies but also gastrectomies and pancreatectomies 10 . The analysis shows increased in-house-mortality associated significantly with PA (among other findings).…”

Section: Introductionmentioning

confidence: 99%

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

Rühlmann¹,

Hedicke²,

Engelhardt³

et al. 2023

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…In upper GI surgery, speci cally in oesophageal resection with an incidence between 16.5% and 23.1% [4][5][6][7] , mechanical manipulation of the myocardium or pericardium is discussed as an important factor. Our previous analysis which investigated the occurrence of PA in patients who underwent upper GI surgery revealed a general incidence of 8.3% 9 . In lower GI surgery different factors are supposed to trigger PA such as an increase in hormonal and sympathetic activity.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] . While the incidence of PA in patients undergoing esophagectomies might also be explained by the thoracic part of this surgery, systemic factors such as imbalance of electrolytes, activation of sympathetic system and hypoxia followed by vasoconstriction of pulmonary veins have also been depicted as relevant pathophysiological factors for the genesis of PA. 8 In a recent study of our group we evaluated the impact of PA in patients after upper GI surgery including not only esophagectomies but also gastrectomies and pancreatectomies 9 . The analysis shows increased in-house-mortality associated signi cantly with PA (among other ndings).…”

Section: Introductionmentioning

confidence: 99%

Postoperative arrhythmia after lower gastrointestinal surgery- the blind spot of postoperative care?

Rühlmann

Hedicke

Engelhardt

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction: Postoperative arrhythmias (PAs) are common events and have been widely investigated in cardiothoracic surgery. Within visceral surgery, a recent study revealed a signi cant 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. Methods: In total, 1171 patients (559 female, 612 male) without any history of prior arrhythmia who underwent lower GI surgery between 2012 and 2018 were included and retrospectively analyzed. All included patients were treated and monitored in the intensive care unit (ICU) or intermediate care unit (IMC) after surgery. Follow-up was obtained for the patients with PA investigating the possible persistence of PA and complications such as permanent arrhythmia or thromboembolic events after discharge.Results: 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 signi cantly associated with higher age (p<0.001) and longer length of stay in the ICU (p<0.001).PA was independently associated with organ failure (p<0.001) and higher in-house mortality (p<0.001). In median, PA occurred 66.5 hours after surgery. In follow-up, 31% of the patients showed development of permanent arrhythmia.Discussion: The incidence of PA after lower GI surgery is comparatively low. Its occurrence, however, seems to have severe implications since it is signi cantly associated with higher rates of organ failure and in-house mortality. Also, compared to the general population, the development of permanent arrhythmia is signi cantly higher in patients who developed new-onset PA.

show abstract

“…A number of studies have reported the incidence of postoperative atrial fibrillation (POAF) ranging from 9.2% to 45.5%. [6][7][8] It was reported that POAF potentially increase the risk of thromboembolic events and mortality. [9] Recent studies have also showed that POAF might be related to other postoperative complications such as pneumonia and anastomotic leakage through decreased organ blood flow.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for the development of postoperative atrial fibrillation after esophagectomy for esophageal cancer

He,

Wu,

Yang

et al. 2023

Medicine

View full text Add to dashboard Cite

Postoperative atrial fibrillation (POAF) is one of the most complications after esophagectomy. Thus, our study was conducted to explore risk factors that are associated with POAF following esophagectomy. In the current study, we retrospectively evaluated 511 patients with esophageal cancer who underwent esophagectomy at our center between May 2018 and December 2020. The incidence of POAF and clinical variables were collected and analyzed. POAF occurred in 62 (12.13%) of 511 patients. Increasing age (P = .004) and lower preoperative albumin level (P = .028) was significantly associated with POAF. The length of stay was significantly increased in patients with POAF when compared to patients without POAF (P = .003). Multivariate analysis suggested that age (odds ratio [OR] = 1.049, 95% confidence interval [CI] = 1.008–1.093, P = .020), hypertension (OR = 2.207, 95% CI = 1.221–3.987, P = .009), respiratory complications (OR = 2.015, 95% CI = 1.130–3.591, P = .018) and Ivor Lewis approach (OR = 3.001, 95% CI = 1.032–8.723, P = .044) were independent risk factors for POAF following esophagectomy. Increasing age, preoperative hypertension, respiratory complications and Ivor Lewis approach are independent risk factors for POAF after esophagectomy. POAF is associated with prolonged length of stay. This study suggests that older patients, patients with hypertension or patients underwent Ivor Lewis approach should be monitored more closely during the postoperative period.

show abstract

Incidence, Associated Risk Factors, and Outcomes of Postoperative Arrhythmia After Upper Gastrointestinal Surgery

Cited by 8 publications

References 30 publications

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

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

Postoperative arrhythmia after lower gastrointestinal surgery- the blind spot of postoperative care?

Risk factors for the development of postoperative atrial fibrillation after esophagectomy for esophageal cancer

Contact Info

Product

Resources

About