Abstract 18447: Peri-operative Atrial Fibrillation (POAF) Complicating Non-cardiothoracic Surgery: A Systematic Review
Introduction: More than 37 million non cardiothoracic operations are performed in the USA per annum. Single studies have reported that peri-operative atrial fibrillation (POAF) complicates non-cardiac surgery in ≤12% of patients. It is not clear if POAF is associated with adverse outcomes. Purpose: We conducted a systematic review to determine the frequency and implications of POAF.
Methods: We conducted a literature search of MEDLINE, Embase, HTA, Cochrane, and Pubmed databases. We defined POAF as a single episode of AF confirmed by ECG within 30 days of non cardiothoracic surgery. Inclusion criteria were published manuscripts and abstracts containing patient level information. We excluded studies which were not published in English, described cardiothoracic surgery, were missing patient-level AF data or included patients aged <18 years.
Results: Our search produced 4445 publications, from which 716 abstracts and 534 manuscripts were identified for review. After applying inclusion/exclusion criteria, 225 manuscripts were analysed. Combining all studies, POAF occurred in 18789/650120 patients (2.9%, n=172, median [IQR] 2.2% [0.9-5.8]). Among 37 prospective studies, POAF occurred in 517/10990 patients (4.7%, n=37, 3.23% [1.0-8.8]). AF was prospectively identified pre-op in 875/26596 (3.3%, n=18, 9.0% [5.5-13.1]) and post-op in 472/14719 (3.2%, n=18, 8.8% [5.5-13.0]). In 135 retrospective studies, POAF occurred in 18272/639130 patients (2.9% n=135, 2.13 [0.8-4.4]). In retrospective analyses, AF was pre-existent in 49756/2440489, (2.0%, n=44, 6.7% [4.3-13.1]) and de novo in 12043/1641875, (0.7%, n=23, 6.0% [1.6-12.3]). Stratifying by surgery type, POAF was most common in vascular (104/1380, 7.5%), followed by orthopaedic (128/2384, 5.4%), and neurosurgical (197/4390, 4.5%) patients. Patient outcomes were not systematically reported: at 1 year, mortality occurred in 927/4136 (22.4%) POAF patients, compared to 8498/63746 (13.3%) non-POAF patients (n=7). Conclusions: POAF occurred in 2.9% of 650120 patients and was associated with a 68% increase in mortality. Prospective research is required to determine whether any specific intervention(s) in POAF patients will improve outcomes.
Author Disclosures: J. Wenner: None. K. Bami: None. H. Samardhi: None. P. Nery: None. D. Birnie: None. G. Nair: None. C. Redpath: None.
- © 2015 by American Heart Association, Inc.