Prediction rule for atrial fibrillation after major noncardiac thoracic surgery.
BACKGROUND
Atrial fibrillation (AF) is a common complication after major noncardiac thoracic surgery and increases the cost and morbidity of these operations. We sought to derive and validate a clinical prediction rule to risk-stratify patients for postoperative AF.


METHODS
For a cohort of cancer patients who underwent noncardiac thoracic surgery, we examined the association of preoperative clinical variables with development of postoperative AF. Logistic regression identified multivariable predictors of AF and a clinical risk score was developed by assigning weighted point scores for the presence of each significant covariate. An independent data set was used for validation purposes.


RESULTS
Of the 856 patients, 147 (17.2%) developed postoperative AF. Male gender (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1 to 2.4), advanced age (55 to 74 years OR 4.4, 95% CI 2.0 to 9.8; > or =75 years OR 9.2, 95% CI 3.9 to 21.5), and preoperative heart rate greater than or equal to 72 beats per minute (OR 1.7, 95% CI 1.2 to 2.5) were independent predictors of postoperative AF. A risk score was assigned with male gender and heart rate greater than or equal to 72 beats per minute each receiving 1 point, and age 55 to 74 and greater than or equal to 75 years receiving 3 and 4 points, respectively. The risk of postoperative AF ranged from 0% (0 points) to 54.6% (6 points) (p < 0.001). The score-based risk in both derivation and validation sets was similar (p = 0.66).


CONCLUSIONS
A prediction rule using clinical variables can be used to predict the risk of postoperative AF after noncardiac thoracic surgery. This information can be used to guide prophylactic therapy.
Passman
Rod S
RS
Northwestern University Feinberg School of Medicine and the Feinberg Cardiovascular Institute, Chicago, Illinois 60611, USA. r-passman@northwestern.edu
Gingold
Daniel S
DS
Amar
David
D
Lloyd-Jones
Donald
D
Bennett
Charles L
CL
Zhang
Hao
H
Rusch
Valerie W
VW
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*