title: Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery.
abstract: BACKGROUND
  Although major noncardiac surgery is common, few large-scale studies have examined the incidence and consequences of post-operative atrial fibrillation (POAF) in this population. We sought to define the incidence of POAF and its impact on outcomes after major noncardiac surgery.
  
  
  METHODS
  Using administrative data, we retrospectively reviewed the hospital course of adults who underwent major noncardiac surgery at 375 US hospitals over a 1-year period. Clinically significant POAF was defined as atrial fibrillation occurring during hospitalization that necessitated therapy.
  
  
  RESULTS
  Of 370,447 patients, 10,957 (3.0%) developed clinically significant POAF while hospitalized. Of patients with POAF, 7,355 (67%) appeared to have pre-existing atrial fibrillation and 3,602 (33%) had newly diagnosed atrial fibrillation. Black patients had a lower risk of POAF (adjusted odds ratio, 0.53; 95% CI, 0.48-0.59; P < .001). Patients with POAF had higher mortality (adjusted odds ratio, 1.72; 95% CI, 1.59-1.86; P < .001), markedly longer length of stay (adjusted relative difference, +24.0%; 95% CI, +21.5% to +26.5%; P < .001), and higher costs (adjusted difference, +$4,177; 95% CI, +$3,764 to +$4,590; P < .001). These findings did not differ by whether POAF was a recurrence of pre-existing atrial fibrillation, or a new diagnosis.
  
  
  CONCLUSIONS
  POAF following noncardiac surgery is not uncommon and is associated with increased mortality and cost. Our study identifies risk factors for POAF, which appear to include race. Strategies are needed to not only prevent new POAF, but also improve management of patients with pre-existing atrial fibrillation.
authors.affiliation: Division of Cardiology, Northwestern University, Chicago, IL, USA. pdbhave@gmail.com
authors.forename: Prashant D
authors.initials: PD
authors.lastname: Bhave
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Judith
authors.initials: J
authors.lastname: Maselli
authors.forename: Andrew
authors.initials: A
authors.lastname: Auerbach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D014481:United States