Original ResearchAugust 2022
A Cohort Study
    Author, Article, and Disclosure Information
    Visual Abstract. Outcomes of Atrial Fibrillation After Noncardiac Surgery.

    Perioperative atrial fibrillation (AF) is not uncommon, yet the morbidity from this arrhythmia is unknown. In this retrospective cohort study, the risk for stroke or transient ischemic attack at 5 years was similar among patients with incident postoperative AF as compared with patients with AF in a nonoperative setting. In addition, anticoagulation was prescribed to only 19.6% of patients that developed postoperative AF. These findings have important clinical, safety, and policy implications for the care and management of AF in the perioperative period.



    Postoperative atrial fibrillation (AF) after noncardiac surgery confers increased risks for ischemic stroke and transient ischemic attack (TIA). How outcomes for postoperative AF after noncardiac surgery compare with those for AF occurring outside of the operative setting is unknown.


    To compare the risks for ischemic stroke or TIA and other outcomes in patients with postoperative AF versus those with incident AF not associated with surgery.


    Cohort study.


    Olmsted County, Minnesota.


    Patients with incident AF between 2000 and 2013.


    Patients were categorized as having AF occurring within 30 days of a noncardiac surgery (postoperative AF) or having AF unrelated to surgery (nonoperative AF).


    Of 4231 patients with incident AF, 550 (13%) had postoperative AF as their first-ever documented AF presentation. Over a mean follow-up of 6.3 years, 486 patients had an ischemic stroke or TIA and 2462 had subsequent AF; a total of 2565 deaths occurred. The risk for stroke or TIA was similar between those with postoperative AF and nonoperative AF (absolute risk difference [ARD] at 5 years, 0.1% [95% CI, −2.9% to 3.1%]; hazard ratio [HR], 1.01 [CI, 0.77 to 1.32]). A lower risk for subsequent AF was seen for patients with postoperative AF (ARD at 5 years, −13.4% [CI, −17.8% to −9.0%]; HR, 0.68 [CI, 0.60 to 0.77]). Finally, no difference was seen for cardiovascular death or all-cause death between patients with postoperative AF and nonoperative AF.


    The population consisted predominantly of White patients; caution should be used when extrapolating the results to more racially diverse populations.


    Postoperative AF after noncardiac surgery is associated with similar risk for thromboembolism compared with nonoperative AF. Our findings have potentially important implications for the early postsurgical and subsequent management of postoperative AF.

    Primary Funding Source:

    National Institute on Aging.