Cited by 285Atrial Fibrillation Management and OutcomesCardiac, Anesthesia and Surgical OutcomesCardiac Valve Diseases and Treatments

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Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs

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LaPar, Damien J., Speir, Alan M., Crosby, Ivan K., Fonner, Edwin, Brown, Michael, Rich, Jeffrey B., Quader, Mohammed, Kern, John A., Kron, Irving L., Ailawadi, Gorav·2014·The Annals of Thoracic Surgery

DOI 10.1016/j.athoracsur.2014.03.039

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Abstract

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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“Similarly, a multicenter observational study by LaPar et al. (2014) found that POAF significantly increases hospital readmission rates, thereby prolonging overall hospitalization and increasing healthcare costs [28].”
Additional file 1 of Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study
St-Onge, S., Chauvette, V., Hamad, R., Bouchard, D., Jeanmart, H., Lamarche, Y., Perrault, L. P., & Demers, P. (2021) · Figshare · doi:10.6084/m9.figshare.14274473
Additional file 3 of Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study
St-Onge, S., Chauvette, V., Hamad, R., Bouchard, D., Jeanmart, H., Lamarche, Y., Perrault, L. P., & Demers, P. (2021) · Figshare · doi:10.6084/m9.figshare.14274479
Additional file 2 of Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study
St-Onge, S., Chauvette, V., Hamad, R., Bouchard, D., Jeanmart, H., Lamarche, Y., Perrault, L. P., & Demers, P. (2021) · Figshare · doi:10.6084/m9.figshare.14274476
Dynamic prediction of paroxysmal atrial fibrillation onset using longitudinal sample entropy in joint models
Ngo, N., de Souza, A. C. R., & Giorgi, R. (2026) · BMC Medical Research Methodology · doi:10.1186/s12874-026-02773-9
“This interval also corresponds to a relevant monitoring period in postoperative cardiac surgery settings, where new-onset atrial fibrillation frequently occurs and is associated with prolonged ICU stay (e.g., 56 vs 40 hours, LaPar et al. [50]).”
Preoperative inflammatory profile in chronic coronary syndrome reveals interleukin-2 as a promising biomarker for postoperative atrial fibrillation risk stratification
Cozac, D. A., Somkereki, C., Nicoară, T. R., Huţanu, A., Demian, L., Cabac‐Pogorevici, I., & Scridon, A. (2026) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2026.101902
“…significance of POAF extends beyond the short perioperative period, since patients who develop POAF after cardiac surgery demonstrate a 30% higher likelihood of hospital readmission within the first month following surgery, creating a substantial burden on both patients and healthcare systems [4].”
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Hauptmann, E., Hoover, E., Chandra, R., Nagaraj, M. B., DeBlieux, P., Ehab, J., & Keshavamurthy, S. (2026) · Annals of Thoracic Surgery Short Reports · doi:10.1016/j.atssr.2026.03.006
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Née, L. (2018) · theses.fr (ABES) · doi:10.70675/5ed59063zc9b9z4173z8601zd836a8ecdb68
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“Across the literature, POAF has consistently been associated with higher rates of stroke, increased mortality, and prolonged hospitalization [1–4].”
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Troy, E. D., Gunst, J., Wouters, P. J., den Berghe, G. V., & Dauwe, D. F. (2026) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-026-04066-0 · Cited by 1
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Liu, X., Chen, X., Liu, L., Gao, Y., & Lv, Y. (2026) · Research Square · doi:10.21203/rs.3.rs-9113833/v1
Post-operative atrial fibrillation, intraoperative autologous blood salvage and transfusion in cardiac surgery
Vieira, S. D., Vieira, F. D. C., Dalmazzo, L. F. F., Akil, F., Fontenele, L. P., de Souza, A. M., Rodrigues, A. P. C., Lira, S. M. D. C., Pessoa, V. D. L. R., & de Castilho, S. L. (2026) · Hematology Transfusion and Cell Therapy · doi:10.1016/j.htct.2026.106467
Bibliometric analysis of postoperative atrial fibrillation following coronary artery bypass grafting surgery
Wang, T. Y., Luo, L., Huang, X., Gao, C., Shu, Y., Ren, Z., & Liu, Y. (2026) · Medicine · doi:10.1097/md.0000000000041773
“In more recent literature, the focus transitions towards examining outcomes post-POAF, [51] encompassing factors like long-term survival rates [23] and cardiovascular event risks.”
A Multi‐Stage Drop‐the‐Loser Design With Superiority Boundaries
Greenstreet, P., Khan, M., Kanji, S., Motazedian, P., SEELY, A. J. E., Sibley, S., & Ramsay, T. (2026) · Statistics in Medicine · doi:10.1002/sim.70642
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Song, J., Wang, J., Wang, X., Fu, Y., Yang, W., Yang, H., Gong, Y., Meng, L., Ding, T., Li, R., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-120083
Racial Differences in the Incidence and Outcomes of Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Grafting: A Systematic Review
Fields, A., Vo, J., Elsherbini, A., Hasheminia, A., Barzegar, N. S., Rodriguez, M., Abu‐Omar, Y., & El-Diasty, M. M. (2026) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2026.07.053
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Restrictive Potassium Supplementation Strategy in a General Intensive Care Unit: A Before-and-After Quality Improvement Audit in a Mixed Critical Care Population
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“This is associated with increased morbidity, prolonged critical care and hospital length of stay, higher rates of stroke, and increased healthcare resource use [9].”

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
ORCID: LaPar, Damien J.
Speir, Alan M.
Quader, Mohammed
Kern, John A.
Kron, Irving L.
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)
DOI: 10.1016/j.athoracsur.2014.03.039
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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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Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs

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