Incidence, Risk Factors, and Outcomes of Perioperative Atrial Fibrillation following Noncardiothoracic Surgery: A Systematic Review and Meta-Regression Analysis of Observational Studies

Abstract

Background. Atrial fibrillation (AF) occurs in 16–30% of patients after cardiac and thoracic surgery and can lead to serious complications like hypoperfusion of vital organs, pulmonary edema, and myocardial infarction. The evidence on risk factors and complications associated with perioperative AF after noncardiothoracic surgery is limited. Methods. The primary objective was to determine demographic and clinical risk factors for new-onset atrial fibrillation associated with noncardiothoracic surgery. A secondary aim was to identify the incidence and odds of perioperative complications associated with the new-onset atrial fibrillation. A systematic search within multiple databases was conducted for studies that explicitly reported on new-onset atrial fibrillation after noncardiothoracic surgery. We reported data on demographics, comorbidities, and perioperative complications as mean difference (MD) or odds ratios (OR) and corresponding 95% confidence interval (CI) using random effects models. A two-sided P value of less than 0.05 was considered significant. We performed meta-regression and sensitivity analysis of various subgroups to confirm the inference of our findings. Results. Eleven studies reporting on 121,517 patients were included, of whom 2,944 developed perioperative AF (incidence rate: 3.7%; 95% CI: 2.3%––6.2%). Advanced age (AF group versus control group: 69.36 ± 10.5 versus 64.37 ± 9.53 years; MD: 4.06; 95% CI: 1.67––6.44; P = 0.0009 ), male gender (52.85% versus 43.59%; OR: 1.08; 95% CI: 0.54 to 1.62; I2: 84%; P < 0.0001 ), preoperative hypertension (60.42% versus 56.51%; OR: 1.15; 95% CI: 1.08 to 1.23; I2: 0%; P < 0.00001 ), diabetes mellitus (22.6% versus 23.04%; OR: 0.97; 95% CI: 0.89 to 1.05; I2: 0; P < 0.00001 ), and cardiac disease (30.64% versus 8.49%; OR: 2.3; 95% CI: 0.28 to 4.31; I2: 93%; P = 0.03 ) were found to be significant predictors for perioperative AF. The AF group was at increased odds of developing postoperative cardiac complications (34.1% versus 5%; OR: 5.44; 95% CI: 0.49 to 10.39; I2: 82%; P = 0.03 ), postoperative stroke (0.5% versus 0.1%; OR: 3; 95% CI: 0.65 to 5.35; I2: 0%; P = 0.01 ), and mortality (7.40% versus 1.92%; OR: 3.58; 95% CI: 0.14 to 7.02; I2: 0%; P = 0.04 ). Study quality assessment by meta-regression and sensitivity analysis of the various subgroups did not affect the final inference of the results. Conclusion. We identified advanced age, male gender, preoperative hypertension, diabetes mellitus, and cardiac disease as important risk factors for perioperative atrial fibrillation. The atrial fibrillation group was at increased odds for postoperative cardiac complications, stroke, and higher mortality, emphasizing the need for risk stratification and close monitoring.

Short- and Long-Term Outcomes of Patients with Postoperative Arrhythmia after Liver Surgery

“…Advanced age, male sex, preoperative hypertension, diabetes mellitus, and cardiac disease were identified as important risk factors for perioperative atrial fibrillation. Faced with an aging and comorbid surgical population, the need for risk stratification and close monitoring increases [18].…”

Modifiable factors associated with postoperative atrial fibrillation in older patients with hip fracture in an orthogeriatric care pathway: a nested case–control study

“…The reported incidence of POAF after non-thoracic non-cardiac surgery varies widely, from 0.5% to 15%, which reflects the heterogeneity in definitions (inclusion or not of patients with a history of AF), methods used to identify POAF, study populations (geriatric or not) and settings (type of surgeries) [ 4 , 6 , 13 ]. We chose to include in this cohort patients with a history of paroxysmal AF, as for previous cohorts of patients with hip fracture.…”

“…Several studies, largely focused on POAF after cardiothoracic surgery, identified factors associated with POAF including baseline characteristics (age, male sex, hypertension, chronic heart failure, ischemic heart disease, chronic kidney disease), and perioperative and postoperative complications (hypovolemia, electrolyte disorders, hypoxemia) [ 4 , 6 , 9 – 12 ]. However, few data are available regarding POAF after non-cardiothoracic surgery, particularly emergent orthopedic surgery [ 4 , 13 ].…”

Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies

“…Historically, the occurrence of POAF in NCS patients was mistakenly perceived as a relatively benign complication, primarily due to its self-limiting nature and asymptomatic presentation. However, recent investigations have illuminated the detrimental impact of POAF, which encompasses hemodynamic instability, prolonged hospitalization, infectious complications, pulmonary complications, heightened risk of stroke, elevated inhospital mortality rates, and escalated healthcare expenditures (2, [6][7][8].…”