Kei Woldendorp1, James Farag2, Sam Khadra3, Deborah Black4, Benjamin Robinson5, Paul Bannon6. 1. Faculty of Health and Medicine, University of Sydney, Sydney, Australia; Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia; Baird Institute of Applied Heart and Lung Research, Sydney, Australia. Electronic address: kei.woldendorp@gmail.com. 2. Faculty of Health and Medicine, University of Sydney, Sydney, Australia; Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia. 3. Faculty of Health and Medicine, University of Sydney, Sydney, Australia. 4. Faculty of Health and Medicine, University of Sydney, Sydney, Australia; Baird Institute of Applied Heart and Lung Research, Sydney, Australia. 5. Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia; Baird Institute of Applied Heart and Lung Research, Sydney, Australia. 6. Faculty of Health and Medicine, University of Sydney, Sydney, Australia; Cardiothoracic Surgical Department, Royal Prince Alfred Hospital, Sydney, Australia; Baird Institute of Applied Heart and Lung Research, Sydney, Australia.
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is common after cardiac surgery and linked to poorer short- and long-term outcomes., however conflicting evidence exists on stroke risk and how the index procedure affects outcomes. This study aims to provide a comprehensive review of the published outcomes of POAF after cardiac surgery, examined as a whole and by index procedure. METHODS: A systematic review of POAF after cardiac surgery was conducted. Outcomes related to POAF were analysed in a meta-analysis and aggregate survival data was derived to examine long-term survival. RESULTS: Sixty-one studies with 239,018 patients were identified, the majority (78.7%) undergoing coronary surgery. POAF occurred in 25.5% of patients and was associated with significantly higher rates of early mortality and stroke (OR 1.74, p <0.001; OR 2.21, p <0.001, respectively) along with longer intensive care and overall hospital length of stay (mean difference 0.8 days, p = 0.008; mean difference 2.8 days, p <0.001, respectively). After a median of 6.6yrs (range 0.5-20), mortality and stroke remained significantly higher for those with POAF (OR 1.57, p <0.001; OR 1.81, p = 0.001). Pooled hazard ratio for long-term mortality was significantly higher for patients who underwent coronary surgery compared to isolated valve surgery. CONCLUSIONS: POAF is common after cardiac surgery and is associated with significantly higher rates of both short- and long-term stroke and mortality as well as increased hospital stay. Differences in hazard for long-term survival may be due to the underlying pathophysiological risk factors for POAF which differ by surgical procedure.
BACKGROUND:Postoperative atrial fibrillation (POAF) is common after cardiac surgery and linked to poorer short- and long-term outcomes., however conflicting evidence exists on stroke risk and how the index procedure affects outcomes. This study aims to provide a comprehensive review of the published outcomes of POAF after cardiac surgery, examined as a whole and by index procedure. METHODS: A systematic review of POAF after cardiac surgery was conducted. Outcomes related to POAF were analysed in a meta-analysis and aggregate survival data was derived to examine long-term survival. RESULTS: Sixty-one studies with 239,018 patients were identified, the majority (78.7%) undergoing coronary surgery. POAF occurred in 25.5% of patients and was associated with significantly higher rates of early mortality and stroke (OR 1.74, p <0.001; OR 2.21, p <0.001, respectively) along with longer intensive care and overall hospital length of stay (mean difference 0.8 days, p = 0.008; mean difference 2.8 days, p <0.001, respectively). After a median of 6.6yrs (range 0.5-20), mortality and stroke remained significantly higher for those with POAF (OR 1.57, p <0.001; OR 1.81, p = 0.001). Pooled hazard ratio for long-term mortality was significantly higher for patients who underwent coronary surgery compared to isolated valve surgery. CONCLUSIONS: POAF is common after cardiac surgery and is associated with significantly higher rates of both short- and long-term stroke and mortality as well as increased hospital stay. Differences in hazard for long-term survival may be due to the underlying pathophysiological risk factors for POAF which differ by surgical procedure.
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