Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality.
OBJECTIVE
Postoperative atrial fibrillation complicates recovery in 20% to 25% of patients after esophagectomy for cancer. The purpose of this study is to understand this phenomenon.


METHODS
Between 1982 and 2000, 198 (22% of 921) patients had postoperative atrial fibrillation after esophagectomy. Propensity scoring and the Greedy Match algorithm were used to develop a cohort of control patients for statistical comparisons. One hundred forty-four patients who had postoperative atrial fibrillation were matched.


RESULTS
Pulmonary complications affected 42% of patients in the atrial fibrillation group compared with 17% in the control group (P <.001). Anastomotic leakage was more common in the atrial fibrillation group (6.9% vs 1.4%, P =.035). Surgical sepsis migrated with atrial fibrillation 4 times more frequently (P =.001). Multivariate analysis demonstrated that postoperative pulmonary complications (odds ratio, 2.5; 95% confidence interval, 1.42-4.3) and surgical sepsis (odds ratio, 3.4; 95% confidence interval, 1.2-9.6) were associated with postoperative atrial fibrillation. The mortality rates of the atrial fibrillation and control groups were 23% and 6.3%, respectively (P <.001). Median survival, excluding hospital deaths, was not different at 14.5 months (atrial fibrillation group) and 16.9 months (control group; P =.4).


CONCLUSIONS
Atrial fibrillation is a surrogate for surgical morbidity and mortality after esophagectomy. The occurrence of atrial fibrillation after esophageal resection should prompt not only the appropriate management of the arrhythmia but also a search for a more ominous underlying cause.
Murthy
Sudish C
SC
Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Law
Simon
S
Whooley
Brian P
BP
Alexandrou
Andreas
A
Chu
Kent-Man
KM
Wong
John
J
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D013530:Surgical Wound Infection; D015996:Survival Rate