Roselli Eric E, Murthy Sudish C, Rice Thomas W, Houghtaling Penny L, Pierce Christopher D, Karchmer Daniel P, Blackstone Eugene H
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):438-44. doi: 10.1016/j.jtcvs.2005.02.010.
To (1) characterize atrial fibrillation complicating lung cancer resection, (2) evaluate its temporal relationship to other postoperative complications, and (3) assess its economics.
From January 1998 to August 2002, 604 patients underwent anatomic lung cancer resection. Atrial fibrillation prevalence, onset, and temporal associations with other postoperative complications were determined. Propensity matching was used to assess economics.
Atrial fibrillation occurred in 113 patients (19%), peaking on postoperative day 2. Older age, male gender, heart failure, clamshell incision, and right pneumonectomy were risk factors (P < .01). Although atrial fibrillation was solitary in 75 patients (66%), other postoperative complications occurred in 38. Respiratory and infectious complications were temporally linked with atrial fibrillation onset. In 91 propensity-matched pairs, patients developing atrial fibrillation had more other postoperative complications (30% vs. 9%, P < .0004), had longer postoperative stays (median 8 vs 5 days, P < .0001), incurred higher costs (cost ratio 1.8, 68% confidence limits 1.6-2.1), and had higher in-hospital mortality (8% vs 0%, P = .01). Even when atrial fibrillation was a solitary complication, hospital stay was longer (median 7 vs 5 days, P < .0001), and cost was higher (cost ratio 1.5, 68% confidence limits 1.2-1.6).
Atrial fibrillation occurs in 1 in 5 patients after lung cancer resection, with peak onset on postoperative day 2. Risk factors are both patient and procedure related, and atrial fibrillation may herald other serious complications. Although often solitary, atrial fibrillation is associated with longer hospital stay and higher cost. It therefore requires prompt treatment and should stimulate investigation for other problems.
(1) 描述肺癌切除术后并发心房颤动的情况；(2) 评估其与其他术后并发症的时间关系；(3) 评估其经济影响。
1998年1月至2002年8月，604例患者接受了肺癌解剖切除术。确定心房颤动的发生率、发作情况以及与其他术后并发症的时间关联。采用倾向匹配法评估经济影响。
113例患者（19%）发生心房颤动，术后第2天达到高峰。年龄较大、男性、心力衰竭、蚌式切口和右肺切除术是危险因素（P <.01）。虽然75例患者（66%）的心房颤动为孤立性，但38例出现了其他术后并发症。呼吸和感染性并发症与心房颤动发作在时间上相关。在91对倾向匹配的病例中，发生心房颤动的患者有更多其他术后并发症（30% 对9%，P <.0004），术后住院时间更长（中位数8天对5天，P <.0001），费用更高（费用比1.8，68% 置信区间1.6 - 2.1），且院内死亡率更高（8% 对0%，P =.01）。即使心房颤动是孤立性并发症，住院时间也更长（中位数7天对5天，P <.0001），费用更高（费用比1.5，68% 置信区间1.2 - 1.
