Factors associated with the development of early postoperative atrial fibrillation in patients after non-cardial surgery

Abstract

Aim. To determine the clinical, instrumental and laboratory factors associated with the development of new-earlypostoperative atrial fibrillation (POAF) in patients after non-cardial surgical interventions. Methods. Cohort retrospective study: 226 case histories were selected from the archive, of which 70 patients were diagnosed with POAF for the first time after non-cardial surgical interventions and 156 patients without it. Results.Patients in the POAF group were statistically significantly older than patients without POAF: the average age was 77 (69;84) years versus 61 (44;71) years (p<0.001), respectively. In addition, patients with POAF were more likely to have a history of myocardial infarction: 30% vs. 8.4% in the group without POAF (p<0.001); more often had a history of cardiac arrhythmias: 35.7% vs. 10.3% with POAF (p<0.001). Thromboembolic complications and pneumonia were more common in the POAF group: 35.7% and 51.4% versus 3.9% and 11%, respectively (p<0.001). There were no differences between the groups in the urgency of surgical intervention. There were also no differences in the volume of postoperative infusion of solutions (p>0.05), the frequency of bleeding after surgery (p=0.290) and the duration of hospitalization (p=0.613).When constructing the logistic regression, it was found that statistically significant independent predictors of POAF development were: myocardial infarction (OR 4.7 at 95% CI 2.2-10.1), history of cardiac arrhythmias (OR 5.0 at 95% CI 2.5-10.3), CHF 2-3 FC (OR 9.9 at 95% CI 5.2-19.1), diabetes mellitus (OR 4.0 at 95% CI 2-8), COPD (OR 8.6 at 95% CI 1.7-42.3), intraoperative infusion of more than 3 liters (OR 3.4 at 95% CI 1.6-7.4). Conclusions.Patients who developed POAF after abdominal surgery are significantly older than patients without POAF, have more pronounced concomitant pathology: they often have a history of myocardial infarction and cardiac arrhythmias, more often suffer from severe chronic heart failure, diabetes mellitus and chronic obstructive pulmonary disease. The development of atrial POAF is more often noted with a large infusion of solutions during surgery, as well as with repeated laparotomies. In the early postoperative period, systemic inflammatory reaction syndrome and thromboembolic complications are more common in patients with POAF.