Karsten Keller1, Lukas Hobohm2, Martin Engelhardt3. 1. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Team Doctor of the German Bundesliga Club 1. FSV Mainz 05 in the Soccer Season 2014/2015, Mainz, Germany. 2. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. 3. Department for Orthopedics, Trauma Surgery and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany; Olympic Doctor of the German Olympic Sports Confederation responsible for taking care of the German team at the Olympic Summer Games 2004 in Athena and 2008 in Beijing.; Head of the Institute for Applied Training Science Leipzig (IAT), Leipzig, Germany.
Abstract
BACKGROUND: Atrial fibrillation/flutter (AF) is associated with increased mortality, thromboembolism, heart failure, and adverse perioperative outcomes. We aimed to investigate the impact of AF on adverse in-hospital outcomes of hospitalized patients who underwent knee endoprosthetic surgery (KES). METHODS: The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Patients who underwent KES were identified based on the surgical and interventional procedural codes (surgery and procedure code [Operationen-und Prozedurenschlüssel] 5-822), and patients were further stratified by AF (International Classification of Diseases and Related Health Problems code I48). We compared patients with and without AF who underwent KES as well as survivors vs nonsurvivors among patients with AF. Logistic regression models were used to investigate the impact of AF as a predictor for adverse in-hospital outcomes. RESULTS: Overall, 1,642,875 hospitalized surgical patients (65.4% females, 49.5% aged >70 years) were included in the analysis. Of these, 93,748 patients (5.7%) were diagnosed with AF. Overall, 0.1% of the patients who underwent KES and 0.6% of the patients who underwent KES with additional AF died during in-hospital stay. All-cause death (risk ratio 5.97 [95% confidence interval {CI} 5.41-6.58], P < .001) and adverse in-hospital events (risk ratio 2.62 [95% CI 2.50-2.74], P < .001) occurred both more often in patients with AF compared to those without. AF was an important predictor for in-hospital death (odds ratio 2.09 [95% CI 1.88-2.32], P < .001) and adverse in-hospital events (odds ratio 1.76 [95% CI 1.68-1.85], P < .001) in patients who underwent KES independent of age, sex, and comorbidities. CONCLUSION: In patients who underwent KES, AF is associated with increased in-hospital mortality and adverse in-hospital outcomes. Pneumonia, pulmonary embolism, shock, myocardial infarction, intracerebral bleeding, and stroke were the key complications promoting in-hospital death.
BACKGROUND:Atrial fibrillation/flutter (AF) is associated with increased mortality, thromboembolism, heart failure, and adverse perioperative outcomes. We aimed to investigate the impact of AF on adverse in-hospital outcomes of hospitalized patients who underwent knee endoprosthetic surgery (KES). METHODS: The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Patients who underwent KES were identified based on the surgical and interventional procedural codes (surgery and procedure code [Operationen-und Prozedurenschlüssel] 5-822), and patients were further stratified by AF (International Classification of Diseases and Related Health Problems code I48). We compared patients with and without AF who underwent KES as well as survivors vs nonsurvivors among patients with AF. Logistic regression models were used to investigate the impact of AF as a predictor for adverse in-hospital outcomes. RESULTS: Overall, 1,642,875 hospitalized surgical patients (65.4% females, 49.5% aged >70 years) were included in the analysis. Of these, 93,748 patients (5.7%) were diagnosed with AF. Overall, 0.1% of the patients who underwent KES and 0.6% of the patients who underwent KES with additional AF died during in-hospital stay. All-cause death (risk ratio 5.97 [95% confidence interval {CI} 5.41-6.58], P < .001) and adverse in-hospital events (risk ratio 2.62 [95% CI 2.50-2.74], P < .001) occurred both more often in patients with AF compared to those without. AF was an important predictor for in-hospital death (odds ratio 2.09 [95% CI 1.88-2.32], P < .001) and adverse in-hospital events (odds ratio 1.76 [95% CI 1.68-1.85], P < .001) in patients who underwent KES independent of age, sex, and comorbidities. CONCLUSION: In patients who underwent KES, AF is associated with increased in-hospital mortality and adverse in-hospital outcomes. Pneumonia, pulmonary embolism, shock, myocardial infarction, intracerebral bleeding, and stroke were the key complications promoting in-hospital death.