Koren Ofir, Hakim Rony, Israeli Asaf, Rozner Ehud, Turgeman Yoav
Heart Institute, Emek Medical Center, Afula, Israel.
Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Cardiol Res Pract. 2020 Oct 14;2020:8156786. doi: 10.1155/2020/8156786. eCollection 2020.
Postoperative new-onset atrial fibrillation (POAF) is a common complication following cardiothoracic surgery, but little is known regarding its occurrence and outcome following noncardiothoracic surgery. This study was intended to examine the incidence of POAF in noncardiothoracic surgeries performed under general anesthesia and its effects on the length of hospitalization stay, short-term and long-term morbidity, and mortality. . We conducted a retrospective observational descriptive study. The study population consists of patients hospitalized in surgical wards from January 2014 to December 2017. Surgery was defined as noncardiac or thoracic procedure conducted under general anesthesia.
A total of 24,125 general anesthesia operations were performed at 7 surgical wards. About two-fifth of the operations (40%) were operated electively, and the rest underwent emergency surgery. The mean age was 63.78 ± 11.50, and more than half (56.9%) of the participants were female. The prevalence of POAF was 2.69 per 1000 adult patients (95% CI: 2.11-3.43) and vary significantly among wards. The highest prevalence was observed after hip fixation and laparotomy surgeries (54.9 and 26.7 per 1000 patients, respectively). The median length of hospitalization was significantly higher in POAF patients (21.0 vs. 4.8 days, < 0.001). Patients who developed POAF had significantly higher mortality rates, both inhospital (200 vs. 7.56 deaths per 1000, =0.001) and 1 year (261.5 vs. 33.3 per 1000, =0.001, respectively). There was no significant association between outcome and treatment modalities such as rate or rhythm control and anticoagulant use.
New-onset AF following noncardiac surgery is rare, yet poses significant clinical implications, both immediate and long-term. POAF is associated with a longer length of hospitalization and a significantly higher mortality rate, both in short- and long-term.
术后新发房颤（POAF）是心胸外科手术后常见的并发症，但对于非心胸外科手术后其发生情况及转归了解甚少。本研究旨在探讨全身麻醉下非心胸外科手术中POAF的发生率及其对住院时间、短期和长期发病率及死亡率的影响。我们进行了一项回顾性观察描述性研究。研究人群包括2014年1月至2017年12月在外科病房住院的患者。手术定义为在全身麻醉下进行的非心脏或胸部手术。
7个外科病房共进行了24,125例全身麻醉手术。约五分之二的手术（40%）为择期手术，其余为急诊手术。平均年龄为63.78±11.50岁，超过一半（56.9%）的参与者为女性。POAF的患病率为每1000例成年患者2.69例（95%CI：2.11 - 3.43），且各病房之间差异显著。髋部固定术和剖腹手术后的患病率最高（分别为每1000例患者54.9例和26.7例）。POAF患者的住院中位时间显著更长（21.0天对4.8天，P<0.001）。发生POAF的患者死亡率显著更高，无论是住院期间（每1000例中有200例死亡对7.56例，P = 0.001）还是1年时（每1000例中有261.5例对33.3例，P = 0.001）。结局与治疗方式如心率或节律控制及抗凝药物使用之间无显著关联。
非心脏手术后新发房颤虽罕见，但具有重大的即刻和长期临床意义。POAF与住院时间延长及短期和长期死亡率显著升高相关。
