Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group.
OBJECTIVE
To determine the incidence, predictors, and cost of atrial fibrillation and flutter (AFIB) following coronary artery bypass graft (CABG) surgery.


METHODS
Prospective observational study (MultiCenter Study of Perioperative Ischemia).


METHODS
Twenty-four university-affiliated hospitals in the United States from 1991 to 1993.


METHODS
A total of 2417 patients undergoing CABG with or without concurrent valvular surgery selected using a systematic sampling interval.


METHODS
Detailed preoperative, intraoperative, and postoperative data collected on standardized reporting forms.


RESULTS
The overall incidence of postoperative AFIB was 27 percent. Independent predictors of postoperative AFIB included advanced age (odds ratio [OR], 1.24 per 5-year increase; 95 percent confidence interval [CI], 1.18-1.31); male sex (OR, 1.41; 95 percent CI, 1.09-1.81); a history of AFIB (OR, 2.28; 95 percent CI, 1.74-3.00); a history of congestive heart failure (OR, 1.31; 95 percent CI, 1.04-1.64); and a precardiopulmonary bypass heart rate of more than 100 beats per minute (OR, 1.59; 95 percent CI, 1.00-2.55). Surgical practices such as pulmonary vein venting (OR, 1.44; 95 percent CI, 1.13-1.83); bicaval venous cannulation (OR, 1.40; 95 percent CI, 1.04-1.89); postoperative atrial pacing (OR, 1.27; 95 percent CI, 1.00-1.62); and longer cross-clamp times (OR, 1.06 per 15 minutes; 95 percent CI, 1.00-1.11) also were identified as independent predictors of postoperative AFIB. Patients with postoperative AFIB remained an average of 13 hours longer in the intensive care unit and 2.0 days longer in the ward when compared with patients without AFIB.


CONCLUSIONS
Postoperative AFIB is common after CABG surgery and has a significant effect on both intensive care unit and overall hospital length of stay. In addition to expected demographic factors, certain surgical practices increase the risk of postoperative AFIB. Randomized controlled trials are necessary to determine if modification of these surgical practices, especially in patients at high risk, would decrease the incidence of postoperative AFIB.
Mathew
J P
JP
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA.
Parks
R
R
Savino
J S
JS
Friedman
A S
AS
Koch
C
C
Mangano
D T
DT
Browner
W S
WS
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology