From the Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Anesth Analg. 2022 Jul 1;135(1):100-109. doi: 10.1213/ANE.0000000000005960. Epub 2022 Feb 25.
New-onset postoperative atrial fibrillation (POAF) is associated with several cardiovascular complications and higher mortality. Several pathophysiological processes such as hypoxia can trigger POAF, but these are sparsely elucidated, and POAF is often asymptomatic. In patients undergoing major gastrointestinal cancer surgery, we aimed to describe the frequency of POAF as automatically estimated and detected via wireless repeated sampling monitoring and secondarily to describe the association between preceding vital sign deviations and POAF.
Patients ≥60 years of age undergoing major gastrointestinal cancer surgery were continuously monitored for up to 4 days postoperatively. Electrocardiograms were obtained every minute throughout the monitoring period. Clinical staff were blinded to all measurements. As for the primary outcome, POAF was defined as 30 consecutive minutes or more detected by a purpose-built computerized algorithm and validated by cardiologists. The primary exposure variable was any episode of peripheral oxygen saturation (Spo2) <85% for >5 consecutive minutes before POAF.
A total of 30,145 hours of monitoring was performed in 398 patients, with a median of 92 hours per patient (interquartile range [IQR], 54-96). POAF was detected in 26 patients (6.5%; 95% confidence interval [CI], 4.5-9.4) compared with 14 (3.5%; 95% CI, 1.94-5.83) discovered by clinical staff in the monitoring period. POAF was followed by 9.4 days hospitalization (IQR, 6.5-16) versus 6.5 days (IQR, 2.5-11) in patients without POAF. Preceding episodes of Spo2 <85% for >5 minutes (OR, 1.02; 95% CI, 0.24-4.00; P = .98) or other vital sign deviations were not significantly associated with POAF.
New-onset POAF occurred in 6.5% (95% CI, 4.5-9.4) of patients after major gastrointestinal cancer surgery, and 1 in 3 cases was not detected by the clinical staff (35%; 95% CI, 17-56). POAF was not preceded by vital sign deviations.
新发术后心房颤动（POAF）与多种心血管并发症和更高的死亡率相关。多种病理生理过程，如缺氧，可引发 POAF，但这些过程尚未得到充分阐明，而且 POAF 常无症状。在接受重大胃肠道癌症手术的患者中，我们旨在描述通过无线重复采样监测自动估计和检测到的 POAF 频率，并次要描述 POAF 与先前生命体征偏差之间的关联。
≥60 岁接受重大胃肠道癌症手术的患者在术后最多 4 天内持续监测。在整个监测期间，每 1 分钟记录一次心电图。临床人员对所有测量均不知情。对于主要结局，POAF 定义为通过专门开发的计算机算法检测到 30 分钟或更长时间的连续分钟，由心脏病专家验证。主要暴露变量是 POAF 前 5 分钟以上任何一次外周血氧饱和度（Spo2）<85%的发作。
共进行了 398 例患者 30145 小时的监测，中位数为每位患者 92 小时（四分位距[IQR]，54-96）。与监测期间临床工作人员发现的 14 例（3.5%；95%CI，1.94-5.83）相比，检测到 26 例（6.5%；95%CI，4.5-9.4）患者发生 POAF。POAF 后住院时间为 9.4 天（IQR，6.5-16），而无 POAF 的患者为 6.5 天（IQR，2.5-11）。POAF 前 Spo2<85%超过 5 分钟的发作（比值比，1.02；95%CI，0.24-4.00；P =.98）或其他生命体征偏差与 POAF 无显著相关性。
重大胃肠道癌症手术后新发 POAF 发生率为 6.5%（95%CI，4.5-9.4），其中 1/3 例未被临床人员发现（35%；95%CI，17-56）。POAF 前无生命体征偏差。
