Risk Factors Analysis of Postoperative Atrial Fibrillation in Video-assisted thoracoscopic surgery for Non-Small Cell Lung Cancer Resection

Abstract

Objective: Postoperative atrial fibrillation ( POAF ) is a frequent complication after lung cancer resection. To identify potential intervention targets, this study aimed to analyze risk contributing factors to the development of POAF in patients undergoing video-assisted thoracoscopic surgery ( VATS ) for non-small cell lung cancer ( NSCLC ) resection. Methods: A retrospective analysis was performed on a cohort of patients who underwent VATS for NSCLC resection at our hospital between January 2016 to October 2019. Patient demographics, preoperative data, and postoperative outcomes were collected and reviewed. Univariate and multivariate analyses were performed to identify significant risk factors for POAF. Results: Among 276 patients who underwent VATS for NSCLC, 29 ( 10.5 % ) developed POAF during hospitalization, and there were no deaths during hospitalization. 25 cases ( 86.2 % ) of POAF occurred within the first three days after surgery. The study established a cut-off age of 73 years, and when patients ' age exceeded this threshold. The incidence of POAF was significantly higher compared to the n-POAF group ( [ 10 ( 34.5 % ) vs. 46 ( 18.6 % ), P = 0.045 ] ). In addition, compared to the n-POAF group, the mediastinal lymph nodes retrieved and node stations explored were significantly higher in the POAF group ( [ median nodes: 10 ( 5,14 ) vs. 6 ( 0,11 ), P = 0.011; median node stations : 3 ( 3, 4 ) vs. 3 ( 0, 3 ), P = 0.005 ). Moreover, the POAF group had higher intraoperative bleeding volume [ 100 ( 50,100 ) vs. 100 ( 100, 200 ) ]. P = 0.034 ] ) and postoperative pulmonary infections ( [ 15 ( 51.7 % ) vs. 55 ( 22.3 % ). The study also identified a significant difference in preoperative hemoglobin levels between the POAF and n-POAF groups ( [ ( 117.63 ± 19.79 ) vs. ( 125.06 ± 16.30 ), P = 0.024] ). Compared to the n-POAF group, the postoperative hospitalization and drainage time were significantly longer in the POAF group ( [ postoperative hospitalization: 11 ( 9, 14 ) vs. 9 ( 6, 12 ), P = 0.024; drainage time: 7 ( 5, 9 ) vs. 5 ( 4, 8 ), P = 0.011 ). Multivariate analysis indicated that postoperative pulmonary infection ( OR: POAF group / n-POAF group = 0.349; 95 % CI 0.149-0.821 ) was an independent risk factor for POAF following VATS for NSCLC. Conclusion: Our study revealed that pulmonary infection was one of the independent risk factors for POAF following VATS in patients with NSCLC. Furthermore, POAF is associated with prolonged drainage time and extended postoperative hospitalization.