Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs
Open accessAbstract
Background New-onset postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. However, the magnitude of POAF on length of stay, resource utilization, and readmission rates remains an area of clinical interest. The purpose of this study was to examine the risk-adjusted impact of POAF on measures of mortality, hospital resources, and costs among multiple centers.Methods A total of 49,264 patient records from a multi-institutional Society of Thoracic Surgeons (STS) certified database for cardiac operations (2001 to 2012) were extracted and stratified by the presence of POAF (19%) versus non-POAF (81%). The influence of POAF on outcomes was assessed by hierarchic regression modeling, adjusted for calculated STS predictive risk indices.Results Mean age was 64±11 years, and median STS predicted risk of mortality for patients who developed POAF were incrementally higher (2% vs 1%, p<0.001) compared with non-POAF patients. The rate of POAF was highest among those undergoing aortic valve replacement+coronary artery bypass grafting, aortic valve, and mitral valve replacement operations. The POAF patients had a higher unadjusted incidence of mortality, morbidity, hospital readmission, longer intensive care unit (ICU) and postoperative length of stay, and higher hospital costs. After risk adjustment, POAF was associated with a twofold increase in the odds of mortality (adjusted odds ratio=2.04, p<0.001), greater hospital resource utilization, and increased costs; POAF was associated with 48 additional ICU hours (p<0.001), 3 additional hospital days (p<0.001), and $3,000 (p<0.001) and $9,000 (p<0.001) of increased ICU and total hospital-related costs, respectively.Conclusions New onset POAF is associated with increased risk-adjusted mortality, hospital costs, and readmission rates. Protocols to reduce the incidence of POAF have the potential to significantly impact patient outcomes and the delivery of high-quality, cost-effective patient care.
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Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.
“Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.927,951,952”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [951]
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“It has been reported that patients with POAF after coronary revascularization or valvular surgery have increased postoperative morbidity and mortality as well as prolonged intensive care unit and hospital stay (2, 19).”
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The long-term impact of postoperative atrial fibrillation after cardiac surgery
Bianco, V. J., Kilic, A., Yousef, S., Serna-Gallegos, D. R., Aranda-Michel, E. C., Wang, Y., Thoma, F. W., Navid, F., & Sultan, I. S. (2022) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2021.10.072 · Cited by 30 · see citing works
Preventive Effect of Berberine on Postoperative Atrial Fibrillation
Zhang, J., Wang, Y., Jiang, H., Tao, D., Zhao, K., Yin, Z., Han, J., Xin, F., Jin, Y., & Wang, H. (2022) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.122.011160 · Cited by 29 · see citing works
Incidence and implications of postoperative supraventricular tachycardia after pulmonary lobectomy
Giambrone, G. P., Wu, X., Gaber-Baylis, L. K., Bhat, A. U., Ramin Zabih, A., Altorki, N. K., Fleischut, P. M., & Stiles, B. M. (2015) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2015.11.057 · Cited by 29 · see citing works
“thoracic surgery.(1,3,6) Because POSVT represents a potentially preventable adverse outcome, the American Association for Thoracic Surgery (AATS)(7) and the Society of Thoracic Surgeons (STS)(8) recently published evidencebased guidelines for the prophylaxis and treatment of POSVT in patients undergoing general thorac…”
BackgroundSchwann, T. A., Al‐Shaar, L., Engoren, M., Bonnell, M. R., Goodwin, M. L., Schwann, A. N., & Habib, R. (2018) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezy028 · Cited by 28 · see citing works
Abouarab, A., Leonard, J. R., Ohmes, L. B., Lau, C., Rong, L. Q., Ivascu, N. S., Pryor, K. O., Munjal, M., Crea, F., Massetti, M., et al. (2017) · Trials · doi:10.1186/s13063-017-2334-4 · Cited by 28 · see citing works
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“mortality, and resource utilization, including length of stay (LOS), readmission, and hospital cost.(4) However, the information regarding the impact of POAF after left ventricular assist device (LVAD) implantation is far less well understood.”
BackgroundMethodResultInfluentialKorantzopoulos, P. G., Sontis, N., Liu, T., Chlapoutakis, S., Sismanidis, S., Siminelakis, S. N., & Apostolakis, E. E. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.03.080 · Cited by 28 · see citing works
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“Previous studies have found postoperative AF to be associated with increased risk of short-term mortality and stroke (6,8,9).”
Pinilla-González, V., Rojas-Solé, C., Gómez-Hevia, F., González-Fernández, T., Cereceda-Cornejo, A., Chichiarelli, S., Saso, L., & Rodrigo, R. (2024) · Foods · doi:10.3390/foods13131999 · Cited by 27 · see citing works
“…surgery corresponds to postoperative AF (POAF), a much-feared complication, as it is associated with an increased length of hospital stay, readmission to the intensive care unit, persistent congestive heart failure, an increased risk of stroke, increased overall costs, and mortality [122,123].”
BackgroundBaribeau, Y. R., Westbrook, B. M., Baribeau, Y., Maltais, S., Boyle, E. M., & Perrault, L. P. (2019) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-019-0999-3 · Cited by 27 · see citing works
Oraii, A., Masoudkabir, F., Pashang, M., Jalali, A., Sadeghian, S., Mortazavi, S. H., Landy, M. G., Pourhosseini, H., Salarifar, M., Mansourian, S., et al. (2022) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezac264 · Cited by 27 · see citing works
Guénancia, C., Pujos, C., Debomy, F., Malapert, G., Laurent, G., & Bouchot, O. (2015) · BioMed Research International · doi:10.1155/2015/703685 · Cited by 27 · see citing works
“POAF is associated with increased duration of hospitalization, with high healthcare costs, and has been associated with an increased incidence of stroke, the need for a permanent pacemaker, and early and late mortality [5, 6].”
BackgroundLing, X., Zhou, H., Ni, Y., Wu, C., Zhang, C., & Zhu, Z. (2018) · PLoS ONE · doi:10.1371/journal.pone.0193303 · Cited by 26 · see citing works
Hassanabad, A. F., Schoettler, F. I., Kent, W. D. T., Adams, C. A., Holloway, D. D., Ali, I. S., Novick, R. J., Ahsan, M. R., McClure, R. S., Shanmugam, G., et al. (2022) · JTCVS Open · doi:10.1016/j.xjon.2022.09.003 · Cited by 26 · see citing works
“Postoperative atrial fibrillation (POAF)(1) and postpericardiotomy syndrome (PPS)(2) are common early complications after cardiac surgery, whereas postsurgical pericardial adhesions and pericardial constriction can have negative long-term consequences on outcomes.(3-10) Although inflammation is believed to play an imp…”
BackgroundOutcome after procedures for retained blood syndrome in coronary surgery
Tauriainen, T., Kinnunen, E., Koski-Vähälä, J., Mosorin, M.-A., Airaksinen, J., & Biancari, F. (2017) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezx015 · Cited by 23 · see citing works
“Its incidence is at least around 20% according to different authors [19, 20].”
BackgroundReducing New-Onset Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Coletta, M., Lis, G. A., Clark, P. C., Dabir, R. R., & Daneshvar, F. (2019) · AACN Advanced Critical Care · doi:10.4037/aacnacc2019470 · Cited by 25 · see citing works
Prevention of atrial fibrillation after open-chest surgery with extracellular vesicle therapy
Parent, S., Vaka, V. R., Risha, Y., Ngo, C., Kanda, P., Nattel, S., Khan, S., Courtman, D. W., Stewart, D. J., & Davis, D. R. (2023) · JCI Insight · doi:10.1172/jci.insight.163297 · Cited by 25 · see citing works
“Despite these measures, a single occurrence of POAF often extends hospital length of stay and increases costs (4, 5).”
BackgroundA Clinical Prediction Model for Postcardiac Surgery Atrial Fibrillation in an Asian Population
Zhang, W., Liu, W., Chew, S. T. H., Shen, L., & Ti, L. K. (2016) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000001384 · Cited by 23 · see citing works
Are Serum Potassium and Magnesium Levels Associated with Atrial Fibrillation After Cardiac Surgery?
Howitt, S. H., Grant, S. W., Campbell, N. G. S., Malagon, I. L., & McCollum, C. N. (2019) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2019.10.045 · Cited by 25 · see citing works
“The median (IQR) number of doses of potassium (20 mmol IV) and magnesium supplementation therapy (20 mmol IV) administered during the first 72 hours of ICU admission were 3 (1-5) and 0 (0-1), respectively.”
MethodGhurram, A., Krishna, N., Bhaskaran, R., Kumaraswamy, N., Jayant, A., & Varma, P. K. (2019) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-019-00844-9 · Cited by 23 · see citing works
Intraoperative Oxygen Treatment, Oxidative Stress, and Organ Injury Following Cardiac Surgery
Lopez, M. G., Shotwell, M. S., Hennessy, C., Pretorius, M., McIlroy, D. R., Kimlinger, M. J., Mace, E. H., Absi, T., Shah, A. S., Brown, N. J., et al. (2024) · JAMA Surgery · doi:10.1001/jamasurg.2024.2906 · Cited by 22 · see citing works
Karabacak, K., Kubat, E., Akyol, F. B., Kadan, M., Erol, G., Doğancı, S., Yıldırım, V., & Bolcal, C. (2020) · Journal of Cardiac Surgery · doi:10.1111/jocs.14898 · Cited by 22 · see citing works
Piccini, J. P., Ahlsson, A., Dorian, P., Gillinov, M. A., Kowey, P. R., Mack, M. J., Milano, C. A., Perrault, L. P., Steinberg, J. S., Waldron, N. H., et al. (2021) · American Heart Journal · doi:10.1016/j.ahj.2021.10.114 · Cited by 22 · see citing works
Quantifying the effect of complications on patient flow, costs and surgical throughputs
Almashrafi, A., & Vanderbloemen, L. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0372-6 · Cited by 22 · see citing works
“Unlike previous studies that have found significant LOS attributable to atrial fibrillation [41, 42], the excess LOS associated with atrial fibrillation in our study was less than 7 h.”
BackgroundCost-effectiveness of second-line vasopressors for the treatment of septic shock
Lam, S. W., Barreto, E. F., Scott, R. A., KASHANI, K. B., Khanna, A. K., & Bauer, S. R. (2019) · Journal of Critical Care · doi:10.1016/j.jcrc.2019.10.005 · Cited by 22 · see citing works
Topal, D., Korkmaz, U. T. K., Velioğlu, Y., Yüksel, A., Dönmez, İ., Uçaroğlu, E. R., & Kayış, S. A. (2022) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20220295 · Cited by 21 · see citing works
Parise, O., Parise, G., Vaidyanathan, A., Occhipinti, M., Gharaviri, A., Tetta, C., Bidar, E., Maesen, B. A. E., Maessen, J. G., Meir, M. L., et al. (2023) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd10020082 · Cited by 21 · see citing works
Increasing Occurrence of Postoperative Atrial Fibrillation in Contemporary Cardiac Surgery
Khan, J., Khan, N., Loisa, E., Sutinen, J., & Laurikka, J. O. (2016) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2016.02.013 · Cited by 21 · see citing works
Kotova, S., Wang, M., Lothrop, K., Grunkemeier, G. L., Merry, H. E., & Handy, J. R. (2017) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2016.11.007 · Cited by 21 · see citing works
“AF after cardiac and noncardiac operations has been associated with the increased morbidity, mortality, increased hospital resource use, and total health care cost [6, 7, 16].”
BackgroundAhmed, M., Belley‐Côté, E. P., Qiu, Y., Belesiotis, P., Tao, B. K.-L., Wolf, A., Kaur, H., Ibrahim, A., Wong, J. A., Wang, M. K., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134534 · Cited by 20 · see citing works
de Waha, S., Schoene, K., Fuernau, G. F., Desch, S., Eitel, I., Pöss, J., Meyer‐Saraei, R., Eitel, C., Tilz, R. R., Schuler, G. C., et al. (2017) · Clinical Research in Cardiology · doi:10.1007/s00392-017-1175-1 · Cited by 20 · see citing works
“Among patients undergoing CABG, the relation of AF and early- as well as long-term outcome is well established [9, 10].”
BackgroundSt-Onge, S., Chauvette, V., Hamad, R., Bouchard, D., Jeanmart, H., Lamarche, Y., Perrault, L. P., & Demers, P. (2021) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-021-01414-0 · Cited by 16 · see citing works
Fibrilación auricular en cirugía cardíaca
Baeza-Herrera, L. A., Velasco, G. R., Márquez-Murillo, M. F., Portillo-Romero, A. D. R., Medina-Paz, L., Álvarez‐Álvarez, R. J., Ramos‐Enríquez, Á., & Baranda-Tovar, F. M. (2019) · Archivos de cardiología de México · doi:10.24875/acm.19000134 · Cited by 18 · see citing works
Fleet, H., Pilcher, D. V., Bellomo, R., & Coulson, T. G. (2021) · Perfusion · doi:10.1177/02676591211037025 · Cited by 18 · see citing works
Yang, Y., Du, Z., Fang, M., Ma, Y., Liu, Y., Wang, T., Han, Z., Peng, Z., Pan, Y., Qin, H., et al. (2023) · Translational research · doi:10.1016/j.trsl.2023.01.001 · Cited by 18 · see citing works
Does Epicardial Adipose Tissue Influence Postoperative Atrial Fibrillation?
Kogo, H., Sezai, A., Osaka, S., Shiono, M., & Tanaka, M. (2018) · Annals of Thoracic and Cardiovascular Surgery · doi:10.5761/atcs.oa.18-00212 · Cited by 18 · see citing works
Tang, B., Song, Y., Cheng, S., Cui, H. Z., Ji, K., Zhao, S., & Wang, S. (2019) · Annals of Thoracic and Cardiovascular Surgery · doi:10.5761/atcs.oa.19-00108 · Cited by 18 · see citing works
O’Quinn, M. P., Dormer, K. J., Huizar, J. F., Nguyen, K. T., Kaszala, K., Sima, A. P., Ellenbogen, K. A., & Tan, A. Y. (2019) · Heart Rhythm · doi:10.1016/j.hrthm.2018.10.014 · Cited by 17 · see citing works
Montgomery, C., Thành, N. X., Stelfox, H. T., Norris, C. M., Rolfson, D. B., Meyer, S. R., Zibdawi, M., & Bagshaw, S. M. (2020) · CJC Open · doi:10.1016/j.cjco.2020.09.009 · Cited by 19 · see citing works
“42 Noncardiac Coagulopathy 6 (12) 12 (3) 0.”
von Haxthausen, F., Ipsen, S., Schwegmann, H., Bruder, R., Ernst, F., & García‐Vázquez, V. (2020) · International Journal of Computer Assisted Radiology and Surgery · doi:10.1007/s11548-020-02171-6 · Cited by 17 · see citing works
Atrial fibrillation in cardiac surgery
Baeza-Herrera, L. A., Velasco, G. R., Márquez-Murillo, M. F., Portillo-Romero, A. D. R., Medina-Paz, L., Álvarez‐Álvarez, R. J., Ramos‐Enríquez, Á., & Baranda-Tovar, F. M. (2020) · Archivos de cardiolog�a de M�xico (English ed Internet) · doi:10.24875/acme.m20000068 · Cited by 17 · see citing works
Miake, J., Kato, M., Ogura, K., Iitsuka, K., Okamura, A., Tomomori, T., Tsujimoto, D., Kato, M., & Yamamoto, K. (2018) · Heart and Vessels · doi:10.1007/s00380-018-1267-5 · Cited by 17 · see citing works
“Atrial fibrillation (AF), one of the commonest arrhythmias [1], is associated with an increased morbidity and mortality [2,3].”
BackgroundHassanabad, A. F., Deniset, J., & Fedak, P. W. M. (2023) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2023.06.003 · Cited by 16 · see citing works
Role of the MAPKs/TGF-β1/TRAF6 signaling pathway in postoperative atrial fibrillation
Zhang, D., Chen, X., Wang, Q., Wu, S., Zheng, Y., & Liu, X. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173759 · Cited by 16 · see citing works
Lagier, D., Née, L., Guieu, R., Kerbaul, F., Fenouillet, E., Roux, N., Giorgi, R., Théron, A., Grisoli, D., Gariboldi, V., et al. (2018) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000000824 · Cited by 16 · see citing works
Attributable Costs of Postoperative Atrial Fibrillation among Patients Undergoing Cardiac Surgery
Kosuma, P., Wachirasrisirikul, S., & Jedsadayanmata, A. (2018) · Cardiology Research and Practice · doi:10.1155/2018/3759238 · Cited by 16 · see citing works
“Patients with combined cardiac surgery had higher rates of overall complication, and this may drive incremental cost of combined cardiac surgery [15].”
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Björn, R., Nissinen, M., Lehto, J., Malmberg, M., Yannopoulos, F., Airaksinen, J. K. E., Hartikainen, J. E. K., Nieminen, T. V. M., Biancari, F., Gunn, J. M., et al. (2021) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2021.03.101 · Cited by 17 · see citing works
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Incidence, Predictors, and Outcomes of Early Atrial Arrhythmias After Lung Transplant
Saad, M. S., Elgendy, I. Y., Mentias, A. G., Abdelaziz, H. K., Barakat, A. F., Abu‐Zaid, A., Elgendy, A. Y., Mojadidi, M. K., Chandrashekaran, S., & Mahmoud, A. N. (2017) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2016.12.009 · Cited by 16 · see citing works
Waldron, N. H., Cooter, M. L., Piccini, J. P., Anstrom, K. J., Klinger, R. Y., Kertai, M. D., Podgoreanu, M. V., Stafford‐Smith, M., Newman, M. F., & Mathew, J. P. (2018) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-018-1119-x · Cited by 16 · see citing works
Concomitant Left Atrial Appendage Closure Outcomes and Cost: A Multi-institutional Cohort Analysis
Hawkins, R. B., Clark, S. S., Mehaffey, J. H., Rich, J. B., Speir, A. M., Quader, M. A., Yarboro, L. T., & Ailawadi, G. (2019) · Journal of Surgical Research · doi:10.1016/j.jss.2019.11.030 · Cited by 15 · see citing works
Bai, C., Liu, Y., Zhao, Y., Ye, Q., Zhao, C., Liu, Y., & Wang, J. (2022) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-022-10267-4 · Cited by 15 · see citing works
“POAF is associated with increased perioperative mortality and morbidity, increased expenses, prolonged hospital stays, and decreased long-term survival [5, 6].”
Background
- Authors
- LaPar, D. J., Speir, A. M., Crosby, I. K., Fonner, E., Brown, M., Rich, J. B., Quader, M., Kern, J. A., Kron, I. L., & Ailawadi, G.
- Affiliations
- University of Virginia (US)
- Inova Health System (US)
- Mary Washington Hospital (US)
- Sentara Heart Hospital (US)
- Virginia Commonwealth University Medical Center (US)
- Corresponding author
- Ailawadi, Gorav
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 98
- Issue
- 2
- Pages
- 527-533
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2069608457
- Cited by
- 285
- References
- 23
- Citations by year
- 2026: 16 · 2025: 25 · 2024: 23 · 2023: 27 · 2022: 34 · 2021: 27 · 2020: 23 · 2019: 25 · 2018: 28 · 2017: 28 · 2016: 16 · 2015: 12 · 2014: 1
- FWCI
- 13.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- postoperative atrial fibrillation, cardiac surgery complications, mortality, hospital readmission, hospital costs, length of hospital stay, intensive care utilization, aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, risk adjustment
- MeSH terms
- Aged, Atrial Fibrillation, Female, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Patient Readmission, Postoperative Complications, Retrospective Studies, Hospital Costs, Risk Adjustment
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