Arakawa Miwa, Miyata Hiroaki, Uchida Naomichi, Motomura Noboru, Katayama Akira, Tamura Kentaro, Sueda Taijiro, Takamoto Shinichi
Department of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan.
Department of Healthcare Quality Assessment Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2015 Jan;99(1):103-8. doi: 10.1016/j.athoracsur.2014.08.019. Epub 2014 Nov 13.
Postoperative atrial fibrillation (POAF) increases considerably the chances of morbidity and mortality after cardiac surgery. The objective of this study was to identify the major risk factors responsible for POAF after thoracic aortic surgery in order to define preventive measures.
We analyzed 12,260 records (between January 1, 2004, and December 31, 2008) obtained from the Japan Adult Cardiovascular Surgery Database. Patients with history of AF were excluded. Data were collected for 12 preoperative and 10 operative risk factors that had been proven or believed to influence POAF. The relationship between the risk factors and outcome was assessed by the Fisher exact test, Student t test, and multiple logistic regression analysis.
The patients' mean age (± standard deviation) was 67.5 ± 12.7 years, and 27% of the subjects were women. The incidence of POAF was 17.1%. The following risk factors were associated with increased POAF: age (p < 0.0001), history of smoking (p < = 0.020), hypertension (p = 0.020), congestive heart failure (p < 0.0001), urgent operation (p = 0.023), and concomitant with nonelective coronary artery bypass (p = 0.022). Postoperative mortality and postoperative stroke were significantly increased in patients with POAF (p < 0.0001 in both cases). The odds ratios for the POAF risk factors were as follows: replacement of the ascending aorta, 1.67; aortic arch, 1.62; aortic root, 1.42; concomitant with valve operation, 1.35; age, 1.27; and urgent operation, 1.22.
Several risk factors contribute to the incidence of POAF after thoracic aortic surgery. We found that POAF significantly increased 30-day operative mortality (p < 0.0001). Our findings can be used to develop a risk stratification system for the prediction of POAF.
术后房颤（POAF）显著增加心脏手术后发病和死亡的几率。本研究的目的是确定胸主动脉手术后导致POAF的主要危险因素，以便制定预防措施。
我们分析了从日本成人心血管外科数据库获得的12260份记录（2004年1月1日至2008年12月31日）。排除有房颤病史的患者。收集了12项术前和10项已被证实或认为会影响POAF的手术危险因素的数据。通过Fisher精确检验、Student t检验和多元逻辑回归分析评估危险因素与结果之间的关系。
患者的平均年龄（±标准差）为67.5±12.7岁，27%的受试者为女性。POAF的发生率为17.1%。以下危险因素与POAF增加相关：年龄（p<0.0001）、吸烟史（p<=0.020）、高血压（p=0.020）、充血性心力衰竭（p<0.0001）、急诊手术（p=0.023）以及同期进行非选择性冠状动脉搭桥术（p=0.022）。POAF患者的术后死亡率和术后卒中显著增加（两种情况均p<0.0001）。POAF危险因素的比值比分别为：升主动脉置换术，1.67；主动脉弓，1.62；主动脉根部，1.42；同期进行瓣膜手术，1.35；年龄，1.27；急诊手术，1.22。
多种危险因素导致胸主动脉手术后POAF的发生。我们发现POAF显著增加了30天手术死亡率（p<0.0001）。我们的研究结果可用于建立预测POAF的风险分层系统。
