Kothari Anai N, Halandras Pegge M, Drescher Max, Blackwell Robert H, Graunke Dawn M, Kliethermes Stephanie, Kuo Paul C, Cho Jae S
Department of Surgery, Loyola University Medical Center, Maywood, Ill; Department of Surgery, One:MAP Surgical Analytics Research Group, Loyola University Chicago, Chicago, Ill.
Department of Surgery, One:MAP Surgical Analytics Research Group, Loyola University Chicago, Chicago, Ill; Stritch School of Medicine, Loyola University Chicago, Chicago, Ill.
J Vasc Surg. 2016 May;63(5):1240-7. doi: 10.1016/j.jvs.2015.12.046. Epub 2016 Mar 19.
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.
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.
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.
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.
本研究旨在确定新发短暂性术后房颤（TPAF）是否会影响腹主动脉瘤（AAA）修复术后的死亡率，并确定TPAF发生的预测因素。
利用2007年至2011年医疗成本和利用项目-州住院患者数据库（佛罗里达州），回顾性确定因主要诊断为AAA而接受开放性主动脉修复或血管内主动脉修复的患者，并对其进行为期1年的纵向监测。比较有和没有TPAF的患者的住院死亡率和1年死亡率。TPAF被定义为术后出现的新发房颤，随后在无房颤病史的患者中自行缓解。采用Cox比例风险模型，对年龄、性别、合并症、破裂状态和修复方法进行校正，以评估1年生存率。使用卡方自动交互检测器决策树，根据术前患者因素建立预测模型，并在加利福尼亚州的患者中进行外部验证。
在15148例接受AAA修复的患者中，TPAF的发生率为3.7%。总体死亡率为4.3%。有TPAF的患者住院死亡率为12.3%，无TPAF的患者为4.0%。在破裂的情况下，两组之间的死亡率差异相似（33.7%对39.9%，P = 0.3）。在控制了年龄、性别、合并疾病严重程度、紧急程度（破裂与未破裂）和修复方法后，TPAF与术后1年死亡率增加（风险比，1.48；P < 0.001）和出院后死亡率增加（风险比，1.56；P = 0.028）相关。基于卡方自动交互检测器的模型（C统计量 = 0.70）被整合到一个基于网络的应用程序中，以预测个体在护理点发生TPAF的概率。
TPAF的发生与未破裂AAA修复患者的死亡风险增加相关。预测模型可用于识别发生TPAF风险最高的患者，并指导干预措施以改善预后。
