Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk

Abstract

Objective The purpose of this study was to determine whether new-onset transient postoperative atrial fibrillation (TPAF) affects mortality rates after abdominal aortic aneurysm (AAA) repair and to identify predictors for the development of TPAF. Methods Patients who underwent open aortic repair or endovascular aortic repair for a principal diagnosis AAA were retrospectively identified using the Healthcare Cost and Utilization Project-State Inpatient Database (Florida) for 2007 to 2011 and monitored longitudinally for 1 year. Inpatient and 1-year mortality rates were compared between those with and without TPAF. TPAF was defined as new-onset atrial fibrillation that developed in the postoperative period and subsequently resolved in patients without a history of atrial fibrillation. Cox proportional hazards models, adjusted for age, gender, comorbidities, rupture status, and repair method, were used to assess 1-year survival. Predictive models were built with preoperative patient factors using Chi-squared Automatic Interaction Detector decision trees and externally validated on patients from California. Results A 3.7% incidence of TPAF was identified among 15,148 patients who underwent AAA repair. The overall mortality rate was 4.3%. The inpatient mortality rate was 12.3% in patients with TPAF vs 4.0% in those without TPAF. In the ruptured setting, the difference in mortality was similar between groups (33.7% vs 39.9%, P = .3). After controlling for age, gender, comorbid disease severity, urgency (ruptured vs nonruptured), and repair method, TPAF was associated with increased 1-year postoperative mortality (hazard ratio, 1.48; P < .001) and postdischarge mortality (hazard ratio, 1.56; P = .028). Chi-squared Automatic Interaction Detector-based models (C statistic = 0.70) were integrated into a Web-based application to predict an individual's probability of developing TPAF at the point of care. Conclusions The development of TPAF is associated with an increased risk of mortality in patients undergoing repair of nonruptured AAA. Predictive modeling can be used to identify those patients at highest risk for developing TPAF and guide interventions to improve outcomes. (J Vasc Surg 2016;63:1240-7.)

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

“…Data from 46,928 patients who underwent vascular surgery were available from 4 studies over a mean follow-up of 29.6 AE 14.2 months. 19,41,47,57 The absolute risk increase for mortality was 8.5 per 100 patient-years for patients with perioperative AF (23.8 vs 15.3 per 100 patient-years; RR: 1.7, 95% CI: 1.2-2.4, I2 ¼ 93%).…”

“…2). 19,34,41,45,47,48,50,53,56,58 Data on 253,218 patients who underwent oesophageal surgery were available from 7 studies with a mean follow-up of 38.4 AE 1.9 months (Supplemental Fig. S3).…”

Transient atrial fibrillation after open abdominal aortic revascularization surgery is associated with increased length of stay, mortality, and readmission rates

“…Furthermore, a study on the effects of TPAF on AAA has recently been reported. 9 Thus, patients with a diagnosis of abdominal aortic dissection or aneurysm of the aorta or its branches were excluded to include only patients with occlusive disease as an indication for surgery. Also excluded were those with a pre-existing diagnosis of AF to ensure that all cases were new onset.…”

“…1 It was then further classified as TPAF or no-TPAF using the same method the authors have used in previous studies. [8][9][10] Two criteria were used to identify patients who developed TPAF. First, the patient should not have had a prior known history of AF (no AF in the 1 year before surgery and no AF present on admission).…”

“…Although it has been thought to be relatively benign and self-limited in the noncardiothoracic setting, its deleterious long-term effects have recently been recognized to extend beyond the postoperative period in both cardiothoracic and noncardiothoracic settings. [4][5][6][7][8][9][10] In fact, it has been shown that the association between perioperative AF and long-term risk of stroke is stronger for noncardiac than for cardiac surgical procedures. 4 The literature on the effects of postoperative AF in the realm of vascular surgery is sparse.…”