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.
Abstract
Background:
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.
Objective:
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.
Design:
Cohort study.
Setting:
Olmsted County, Minnesota.
Participants:
Patients with incident AF between 2000 and 2013.
Measurements:
Patients were categorized as having AF occurring within 30 days of a noncardiac surgery (postoperative AF) or having AF unrelated to surgery (nonoperative AF).
Results:
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.
Limitation:
The population consisted predominantly of White patients; caution should be used when extrapolating the results to more racially diverse populations.
Conclusion:
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.
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Author, Article, and Disclosure Information
Konstantinos C. Siontis,
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (K.C.S., B.J.G.)
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota (S.A.W., R.J.)
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, and Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (V.L.R.)
Department of Cardiovascular Medicine and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (P.A.N.)
Department of Cardiovascular Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota (A.M.C.).
Disclaimer: This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Acknowledgment: The authors thank Deborah S. Strain for her assistance with formatting and submission of the manuscript.
Financial Support: This work was supported by the National Institute on Aging (R21 AG062580) and was made possible using the resources of the REP, which is supported by the National Institute on Aging (R01 AG058738), the Mayo Clinic Research Committee, and fees paid annually by REP users.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-0434.
Reproducible Research Statement: Study protocol: Available on request from Dr. Chamberlain (e-mail, chamberlain.
Corresponding Author: Alanna M. Chamberlain, PhD, Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, chamberlain.
Author Contributions: Conception and design: A.M. Chamberlain, B.J. Gersh, P.A. Noseworthy, V.L. Roger, K.C. Siontis.
Analysis and interpretation of the data: A.M. Chamberlain, B.J. Gersh, R. Jiang, P.A. Noseworthy, V.L. Roger, K.C. Siontis, S.A. Weston.
Drafting of the article: A.M. Chamberlain, B.J. Gersh, R. Jiang, K.C. Siontis.
Critical revision of the article for important intellectual content: P.A. Noseworthy, V.L. Roger, K.C. Siontis, S.A. Weston.
Final approval of the article: A.M. Chamberlain, B.J. Gersh, R. Jiang, P.A. Noseworthy, V.L. Roger, K.C. Siontis, S.A. Weston.
Statistical expertise: S.A. Weston.
Obtaining of funding: A.M. Chamberlain.
Collection and assembly of data: R. Jiang.
This article was published at Annals.org on 26 July 2022.
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