Impact of a Perioperative Prophylaxis Guideline on Post–Cardiothoracic Surgery Atrial Fibrillation

Li, Rosanna; White, C Michael; Mehmeti, Jola; Martin, Spencer T.; Hobbs, Laura

doi:10.1177/1060028017709290

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…The administration of ibuprofen increased by 28%, from 2% receiving the drug in 2010 to 30% in 2015 ( Figure 1). Adherence to these clinical practice guidelines was greater than that observed in other surgical specialties 25 , 26 …”

Section: Discussionmentioning

confidence: 81%

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Does Ibuprofen Increase Bleed Risk for Pediatric Tonsillectomy?

Leung

DeVore

Kawai

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate risk factors for pediatric posttonsillectomy hemorrhage (PTH) and the need for transfusion using a national database. Study Design Retrospective cohort study. Setting The study was conducted using the Pediatric Health Information System (PHIS) database. Methods Children ≤18 years who underwent tonsillectomy with or without adenoidectomy (T±A) between 2004 and 2015 were included. We evaluated the risk of PTH requiring cauterization according to patient demographics, comorbidities, indication for surgery, medications, year of surgery, and geographic region. Results Of the 551,137 PHIS patients who underwent T±A, 8735 patients (1.58%) experienced a PTH. The risk of PTH increased from 1.33% (95% confidence interval [CI]: 1.15%, 1.53%) in 2010 to 1.91% (95% CI: 1.64%, 2.24%) in 2015 ( P < .001). Older age (≥12 vs <5 years old: adjusted odds ratio [aOR] 3.17; 95% CI: 2.86, 3.52), male sex (aOR 1.11; 95% CI: 1.05, 1.17), medical comorbidities (aOR 1.18; 95% CI: 1.08, 1.29), recurrent tonsillitis (aOR 1.15; 95% CI: 1.07, 1.24), and intensive care unit admission (aOR 1.74; 95% CI: 1.55, 1.95) were significantly associated with an increased risk of PTH. Use of ibuprofen (aOR 1.36; 95% CI: 1.22, 1.52), ketorolac (aOR 1.39; 95% CI: 1.14, 1.69), anticonvulsant (aOR 1.23; 95% CI: 1.03, 1.76), and antidepressants (aOR 1.35; 95% CI: 1.03, 1.76) were also associated with an increased risk of PTH. The need for blood transfusion was 2.1% (181/8735). Conclusion The incidence of PTH increased significantly between 2011 and 2015, and ibuprofen appears to be one contributing factor. Given the benefits of ibuprofen, it is unclear whether this increased risk warrants a change in practice.

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Section: Discussionmentioning

confidence: 81%

“…Adherence to these clinical practice guidelines was greater than that observed in other surgical specialties. 25,26 Ibuprofen and Its Effect on PTH…”

Section: Effect Of Aao-hns Clinical Practice Guidelinementioning

confidence: 99%

Does Ibuprofen Increase Bleed Risk for Pediatric Tonsillectomy?

Leung

DeVore

Kawai

et al. 2020

Otolaryngol.--head neck surg.

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“…Continuously monitoring heart rhythms during hospitalization captures most AF, and the proportion of patients with POAF who are discharged from hospital is very small. Fourth, the findings from a recent study (41) show that administering beta-blockers preoperatively can reduce the incidence of POAF after cardiac surgery. In this study, most patients received beta-blockers before surgery, which may have led to an underestimation of the actual incidence of POAF.…”

Section: Limitationsmentioning

confidence: 97%

The preoperative glomerular filtration rate predicts new-onset postoperative atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy who undergo isolated septal myectomy

et al. 2021

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Background: Few studies have focused on new-onset postoperative atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy who have undergone septal myectomy. Therefore, we investigated the incidence and prognosis effects of postoperative atrial fibrillation following septal myectomy in patients with hypertensive obstructive cardiomyopathy. Additionally, we investigated the relationship of estimated glomerular filtration rate and postoperative atrial fibrillation.Methods: Data from 300 patients with hypertrophic obstructive cardiomyopathy who underwent isolated surgical septal myectomy were collected from January 2012 to March 2018. Results: The overall incidence of postoperative atrial fibrillation during hospitalization was 22.67% (68 of 300 patients). Patients with postoperative atrial fibrillation were older (P<0.001), had lower preoperative estimated glomerular filtration rate (P<0.001), and a larger preoperative left atrial diameter (P=0.038) compared to patients without. The preoperative estimated glomerular filtration rate predicted postoperative atrial fibrillation with sensitivity and specificity of 0.824 and 0.578 (P<0.001), respectively. Multivariate regression analyses showed that age [odds ratio (OR) =1.090, 95% confidence interval (CI): 1.034-1.110], an New York Heart Association functional class ≥ III (OR =2.985, 95% CI: 1.349-6.604), hypertension (OR =2.212, 95% CI: 1.062-4.608), a history of syncope (OR =3.890, 95% CI: 1.741-8.692), and the preoperative estimated glomerular filtration rate (OR =0.981, 95% CI: 0.965-0.996) were independent risk factors associated in the development of postoperative atrial fibrillation. Survival analysis showed that the incidence of long-term cardiovascular events was higher in the patients with postoperative atrial fibrillation than that in the patients without the condition (P<0.001). Conclusions:The preoperative estimated glomerular filtration rate was a moderate predictor of postoperative atrial fibrillation after septal myectomy. Postoperative atrial fibrillation affected the early recovery and the long-term prognoses of patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy.

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