Does laparoscopic surgery decrease the risk of atrial fibrillation after foregut surgery?
BACKGROUND
Atrial fibrillation, which occurs in 12% of all major foregut surgeries, can prolong hospital stay and increase morbidity. Minimally invasive techniques in foregut surgery have been suggested to cause less tissue trauma. We examined the factors associated with new-onset atrial fibrillation after foregut surgery at our institution.


METHODS
We retrospectively examined the records of 154 adult patients who underwent major foregut surgery which included esophagectomy, partial or total gastrectomy, redo Heller myotomy, redo or transthoracic fundoplications. Univariate and multivariate logistic regression analysis with standard modeling techniques were performed to determine risk factors for new-onset atrial fibrillation.


RESULTS
Of the 154 patients, 14 patients developed new-onset atrial fibrillation with a higher mean age of 67.1 years (+/-8.8 years) versus 56.4 years (+/-14.1 years) (p = 0.006). Laparoscopic (p = 0.004) and nonthoracic surgeries (p = 0.01) were associated with lower risk of atrial fibrillation. Patients with atrial fibrillation had received more fluid (6.5 +/- 2.8 liters versus 5.3 +/- 2.0 liters) and had longer operations (370 +/- 103 min versus 362 +/- 142 min), none of which were statistically significant. The average intensive care length of stay of patients was longer: 7.5 +/- 6.8 days versus 4.0 +/- 7.1 days (p = 0.004). Multivariate analysis revealed an association of atrial fibrillation with age (OR 1.08, 95% CI 1.02-1.14, p = 0.01), and laparoscopic surgery (OR 0.09, 95% CI 0.01-0.95, p = 0.04) after adjusting for surgery type.


CONCLUSIONS
Laparoscopic surgery is associated with lower risk of atrial fibrillation in foregut surgery. Development of atrial fibrillation is associated with increased length of intensive care stay. We recommend a prospective trial to confirm our findings.
Turaga
Kiran K
KK
Department of Surgery, Creighton University Medical Center, 601 N 30th street, Omaha, NE 68131, USA.
Shah
Kinjal U
KU
Neill
Erin O
EO
Mittal
Sumeet K
SK
D000328:Adult; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors