Abstract 20601: Atrial Fibrillation Complicating Non-Cardiothoracic Surgery (POAF) is Associated With Increased Mortality and Stroke: A Systematic Review
Introduction: More than 37 million non-cardiothoracic operations are performed per year in the USA alone. Single studies have reported that POAF complicates non-cardiothoracic surgery in up to 12% of patients and may be associated with adverse outcomes.
Purpose: We performed a systematic review to determine the frequency and implications of POAF complicating non-cardiothoracic surgery.
Methods: We searched the MEDLINE, Embase, HTA, Cochrane, and Pubmed databases for primary data describing POAF frequency and outcomes on February 2, 2015. Reference lists of included manuscripts were mined for relevant publications. A second Pubmed search was conducted on February 8, 2016. We defined POAF as AF or atrial flutter documented within 30 days of non-cardiothoracic surgery. We included publications describing POAF frequency and/or outcomes. We excluded case reports, publications that were non-English, described cardiothoracic surgical patients, were missing AF frequency data or included patients aged <18 years.
Results: Our searches produced 5602 titles; 714 publications were identified for review and we analyzed 254 publications. POAF occurred in 29798/ 776932 patients (3.8%, n=186; median [IQR] 2.3% [1.0-5.9]). Preoperative AF was identified in 148402/ 4265675 patients (3.5%, n=80; 7.6% [4.3-13.3]) and de novo postoperative AF was identified in 15589/ 1781960 patients (0.9%, n=54; 6.7% [3.5-12.2]). One-year postoperative mortality occurred in 2446/74314 (3.3%) POAF patients, versus 13748/799694 (1.7%) non-AF patients (OR [95% CI] 2.9 [2.3-3.7], p<0.001). One-year postoperative stroke occurred in 1539/100930 (1.5%) POAF patients, versus 14243/2557767 (0.6%) non-AF patients (OR 2.5 [1.4-4.3], p=0.001) [Fig. 1].
Conclusion: POAF complicates non-cardiothoracic surgery in approximately 4% of patients and is associated with significantly increased 1-year mortality and stroke. Prospective research is needed to confirm these findings.
Author Disclosures: J.B. Wenner: None. K. Bami: None. H. Samardhi: None. P. Nery: None. D. Birnie: None. G. Nair: None. C.J. Redpath: None.
- © 2016 by American Heart Association, Inc.