Reduced atrial fibrillation in patients immediately extubated after off-pump coronary artery bypass grafting.
BACKGROUND
We analyzed data from patients undergoing off-pump isolated coronary artery bypass grafting surgery (OPCABG) to determine if immediate extubation in the operating room affected the incidence of postoperative atrial fibrillation.


METHODS
The study group comprised 2,376 consecutive OPCABG patients operated on between January 1, 2000, and December 31, 2004, by 22 surgeons at 18 hospitals. The data were subjected to univariate, multivariate analysis of variance, and logistic analysis. Logistic regression of matched groups was used to eliminate the effect of some confounding variables.


RESULTS
Patients immediately extubated after surgery had a reduced incidence of atrial fibrillation (10.6% versus 18.5%; p < 0.001), shorter length of stay (4.8 +/- 3.5 versus 6.3 +/- 5.2 days; p < 0.001), and also reduced mortality (1.1% versus 2.4%; p = 0.04). Logistic analysis identified as significant factors for postoperative atrial fibrillation, postoperative ventilator usage (p < 0.001; odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.24 to 2.14), male sex (p = 0.002; OR = 1.51; 95% CI: 1.17 to 1.96), previous CABG (p = 0.005; OR = 0.43; 95% CI: 0.24 to 0.78). Congestive heart failure may also be a contributing factor. In patient groups matched for their risk of mortality, postoperative ventilator use (p < 0.001; OR = 1.80; 95% CI: 1.31 to 2.47), increasing age, and male sex were all statistically significant risk factors. When patient groups were matched on a combination of factors including preoperative beta-blocker usage, pulmonary disease, and smoking, postoperative ventilator use (p = 0.005; OR = 1.66; 95% CI: 1.16 to 2.38), along with increasing age, male sex, and previous CABG (reduced odds of atrial fibrillation developing) were statistically significant.


CONCLUSIONS
Immediate extubation after OPCABG appears to reduce the incidence of postoperative atrial fibrillation independent of comorbidities.
Edgerton
James R
JR
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. edgertonjr@aol.com
Herbert
Morley A
MA
Prince
Syma L
SL
Horswell
Jeffrey L
JL
Michelson
Luis
L
Magee
Mitchell J
MJ
Dewey
Todd M
TM
Edgerton
Zachary J
ZJ
Mack
Michael J
MJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control*; D015331:Cohort Studies; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data*; D020878:Device Removal; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011184:Postoperative Period; D012086:Reoperation; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors; D015300:Ventilator Weaning
D000319:Adrenergic beta-Antagonists