Kim M H, Deeb G M, Morady F, Bruckman D, Hallock L R, Smith K A, Karavite D J, Bolling S F, Pagani F D, Wahr J A, Sonnad S S, Kazanjian P E, Watts C, Williams M, Eagle K A
Cardiovascular Division, Washington University St. Louis, St. Louis, Missouri 63110, USA.
Am J Cardiol. 2001 Apr 1;87(7):881-5. doi: 10.1016/s0002-9149(00)01530-7.
Atrial fibrillation (AF) after cardiac surgery is thought to increase length of stay (LOS). A clinical pathway focused on the management of postoperative AF, including prophylaxis with beta blockers, was implemented to assess the effect of AF on LOS after cardiac surgery. Data were obtained on consecutive cardiac surgery patients in preoperative normal sinus rhythm, no prior history of AF, and no chronic antiarrhythmic therapy from January to May 1995 (control) and November 1996 to June 1997 (pathway). Statistical analysis was performed to assess the effect of postoperative AF on the LOS, clinical outcomes, and cost after cardiac surgery. Despite the clinical pathway, the LOS (7 days for both periods; p = 0.12) and incidence of AF (28.9% vs 28.4%; p = 0.92) remained unchanged. Unadjusted direct costs were 15% higher in the pathway period (p <0.001). Increased rates of beta-blocker therapy had a marginal effect on the incidence of postoperative AF, except in the group who only underwent primary coronary artery bypass graft surgery (31.2% vs 25.3%; p = 0.31). Multivariate analysis revealed that AF contributed only 1 to 1.5 days to the LOS. Thus, this investigation represents the most recent analysis of the effects of postoperative AF on LOS, clinical outcomes, and cost after cardiac surgery. Unlike prior studies, the impact of postoperative AF is less prominent in the current era of cardiac surgical care regardless of the presence of a clinical pathway addressing AF.
心脏手术后的心房颤动（AF）被认为会延长住院时间（LOS）。实施了一项专注于术后房颤管理的临床路径，包括使用β受体阻滞剂进行预防，以评估房颤对心脏手术后住院时间的影响。收集了1995年1月至5月（对照组）以及1996年11月至1997年6月（临床路径组）连续接受心脏手术、术前为正常窦性心律、无房颤病史且未接受慢性抗心律失常治疗的患者的数据。进行统计分析以评估术后房颤对心脏手术后住院时间、临床结局和成本的影响。尽管有临床路径，但住院时间（两个时期均为7天；p = 0.12）和房颤发生率（28.9%对28.4%；p = 0.92）仍未改变。临床路径组未经调整的直接成本高出15%（p <0.001）。β受体阻滞剂治疗率的增加对术后房颤的发生率有轻微影响，但仅接受初次冠状动脉旁路移植手术的组除外（31.2%对25.3%；p = 0.31）。多变量分析显示，房颤仅使住院时间延长1至1.5天。因此，本研究代表了对心脏手术后房颤对住院时间、临床结局和成本影响的最新分析。与先前的研究不同，在当前心脏外科护理时代，无论是否存在针对房颤的临床路径，术后房颤的影响都不那么突出。
