Core Surgical Trainee, Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK.
Clinical Research Fellow, Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.
J Surg Res. 2019 Jun;238:23-28. doi: 10.1016/j.jss.2019.01.017. Epub 2019 Feb 5.
Atrial fibrillation (AF) is a common dysrhythmia that can occur after major physiological stress including surgery (postoperative AF). There are few data on postoperative AF after abdominal surgery. We set out to define the incidence of de novo postoperative AF after abdominal surgery and associated risk factors.
The Patient History Integrated Data store administrative database was interrogated for patients aged ≥65 y undergoing abdominal surgery from April 2012 to April 2014. Patients with pre-existing AF were excluded. The primary outcome was diagnosis of AF.
Two thousand nine hundred and sixty-seven cases were included of whom 187 developed postoperative AF within 90 d (6.3%). The rate of postoperative AF varied by operation and was highest in small bowel resection (17.2%) and lowest in biliary surgery (4.8%). Median time to detection of postoperative AF was 32 d. Patients who developed postoperative AF were significantly older than those who did not develop AF (median age 75.3 y versus 72.4 y, P < 0.01). Logistic regression modeling found increasing age (odds ratio [OR] 1.03 [confidence interval {CI} 1.01-1.06], hypertension OR 1.73 [CI 1.19-2.51]), congestive cardiac failure (OR 3.04 [CI 1.88-4.92], and vascular disease OR 2.29 [CI 1.39-3.37]) were predictive of the development of postoperative AF within 30 d. The area under the curve for this model was 0.733.
Postoperative AF affects a significant number of patients after abdominal surgery. Demographics such as history of cardiovascular disease might aid prediction of postoperative AF. Postoperative AF is mostly identified after discharge, suggesting the need for postoperative screening.
心房颤动（AF）是一种常见的心律失常，可发生于重大生理应激后，包括手术（术后 AF）。关于腹部手术后发生的术后 AF 的数据很少。我们旨在确定腹部手术后新发术后 AF 的发生率及其相关危险因素。
从 2012 年 4 月至 2014 年 4 月，通过查询患者病史综合数据存储管理数据库，筛选出年龄≥65 岁接受腹部手术的患者。排除有预先存在的 AF 的患者。主要结局是诊断为 AF。
共纳入 2967 例患者，其中 187 例在 90 天内发生术后 AF（6.3%）。术后 AF 的发生率因手术而异，小肠切除术最高（17.2%），胆道手术最低（4.8%）。术后 AF 的中位检出时间为 32 天。发生术后 AF 的患者明显比未发生 AF 的患者年龄更大（中位数年龄 75.3 岁比 72.4 岁，P<0.01）。逻辑回归模型发现，年龄增长（优势比[OR] 1.03[置信区间{CI} 1.01-1.06]）、高血压（OR 1.73[CI 1.19-2.51]）、充血性心力衰竭（OR 3.04[CI 1.88-4.92]）和血管疾病（OR 2.29[CI 1.39-3.37]）是术后 30 天内发生术后 AF 的预测因素。该模型的曲线下面积为 0.733。
腹部手术后，相当数量的患者发生术后 AF。心血管疾病史等人口统计学因素可能有助于预测术后 AF。术后 AF 大多在出院后发现，提示需要术后筛查。
