Background and Purpose— Although believed to be transient and self-limiting, new-onset perioperative/postoperative atrial fibrillation (POAF) might be a risk factor for stroke and mortality. We conducted a systematic review and meta-analysis to qualitatively and quantitatively evaluate the relationship of POAF with early and late risks of mortality and stroke. Methods— We searched Pubmed, EMBASE, and Cochrane Library (1966 through March 2018) to identify cohort studies that reported stroke and mortality associated with POAF. We computed a random-effects estimate based on the Mantel-Haenszel method. Odds ratios with 95% CI were used as a measure of the association between POAF and early (in-hospital or within 30 days of surgery) stroke and mortality, while hazard ratios (HR) were used for long-term outcomes. Results— Our analysis included 35 studies with 2 458 010 patients. Pooling the results from the random-effects model showed that POAF was associated with increased risks of early stroke (odds ratio, 1.62; 95% CI, 1.47–1.80), early mortality (odds ratios, 1.44; 95% CI, 1.11–1.88), long-term stroke (HR, 1.37; 95% CI, 1.07–1.77), and long-term mortality (HR, 1.37; 95% CI, 1.27–1.49). Analyses focusing on high-quality studies obtained similar results. In subgroup analyses, POAF was more strongly associated with stroke in patients undergoing noncardiac surgery (HR, 2.00; 95% CI, 1.70–2.35) than in patients undergoing cardiac surgery (HR, 1.20; 95% CI, 1.07–1.34). Conclusions— New-onset POAF is associated with an increased risk of stroke and mortality, both in the short-term and long-term. The best strategy to reduce stroke risk among these patients needs to be determined.

Background: Although perioperative atrial fibrillation is believed to be self-limited, several studies have shown an association between perioperative atrial fibrillation and higher risk of perioperative stroke and mortality. Objectives: To perform a systematic review and meta-analysis to - 1) comprehensively evaluate the qualitative and quantitative relationships of perioperative atrial fibrillation with subsequent risk of stroke and mortality; 2) assess any differences in outcomes among major subgroups. Methods: We searched PudMed and EMBASE for articles published from 1966 to December 2016. We included studies that assessed and reported quantitative estimates of the multivariate adjusted hazard ratio (HR) and 95% confidence interval (CI) for subsequent stroke and mortality associated with perioperative or postoperative atrial fibrillation, or both. We excluded studies that had a cross-sectional or case-control design, that included patients with preexisting atrial fibrillation before surgery, and that did not report 95% CI. Result: There were eight articles included in our primary analysis: three articles included both stroke and mortality as endpoints, four articles only assessed mortality, and one article only evaluated stroke. Pooling results using a random-effect model showed an association between perioperative atrial fibrillation and both subsequent stroke risk (HR, 1.6; 95% CI, 1.3-2.0) and mortality risk (HR, 1.3; 95% CI, 1.2-1.3) (Figure). In subgroup analyses, the association between perioperative atrial fibrillation and stroke was stronger in patients who underwent non-cardiac surgery (HR, 2.0; 95% CI, 1.8-2.3) than in those who received cardiac surgery (HR, 1.5; 95% CI, 1.2-1.8). Conclusions: New onset perioperative atrial fibrillation is associated with an increased risk of both stroke and mortality. This association is stronger among those undergoing non-cardiac surgery than cardiac surgery.

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