title: Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection.
abstract: OBJECTIVE
  Postoperative atrial fibrillation (PAF) occurs commonly following pulmonary resection. Our aims were to quantify the incidence and severity of PAF using the Thoracic Morbidity & Mortality classification system, and identify risk factors for PAF.
  
  
  METHODS
  All consecutive patients undergoing pulmonary resection at a single centre (January 2008 - April 2010) were enrolled. PAF was defined as postoperative, electrocardiographically documented and requiring initiation of pharmacological therapy. Univariate and multivariate analyses of risk factors associated with the development of PAF were conducted.
  
  
  RESULTS
  The incidence of PAF was 11.8% (n = 43) of 363 pulmonary resections (open: n = 173; 47.7%; video-assisted: n = 177; 48.8%; converted: n = 13; 3.6%): sublobar (n = 93; 25.6%), lobectomy (n = 237; 65.3%), bilobectomy (n = 7; 1.9%) and pneumonectomy (n = 24; 6.6%). Twenty-eight cases (65.1%) were uncomplicated/transient, and 15 cases (34.9%) were complicated/persistent PAF, defined as lasting for >7 days (40.0%), requiring cardioversion (13.3%), vasopressors (33.3%), in-hospital use of anticoagulants (46.7%) and/or anticoagulants on discharge (26.7%). Patients with PAF had increased mean lengths of hospital stay (10.5 days vs 6.9 days; P = 0.04). Peak onset of PAF occurred 2.5 (standard deviation (SD) ± 1.3) days after pulmonary resection, lasting for 1.8 ± 2.8 (mean, ±SD) days. Multivariate analysis identified (relative risk; 95% confidence interval): age ≥70 years (2.3; 1.1-5.1), history of angioplasty/stents/angina (4.0; 1.4-11.3), thoracotomy (3.6; 1.4-9.3), conversion to open thoracotomy (16.5; 2.2-124.0) and extent of surgery/stage (7.1; 1.0-49.4) as predictors of PAF.
  
  
  CONCLUSIONS
  While the majority of PAF is uncomplicated and transient, one-third of cases lead to persistence or major intervention. Age, coronary artery disease and extent of surgery/stage increase the risk of PAF following pulmonary resection. Identifying patients with elevated risk may lead to targeted prophylaxis to reduce the incidence of PAF.
authors: Faculty of Medicine, University of Ottawa, Ottawa, Canada.
authors: Jelena
authors: J
authors: Ivanovic
authors: Donna E
authors: DE
authors: Maziak
authors: Sarah
authors: S
authors: Ramzan
authors: Anna L
authors: AL
authors: McGuire
authors: Patrick James
authors: PJ
authors: Villeneuve
authors: Sebastien
authors: S
authors: Gilbert
authors: R Sudhir
authors: RS
authors: Sundaresan
authors: Farid M
authors: FM
authors: Shamji
authors: Andrew J E
authors: AJ
authors: Seely
mesh_terms: D000367:Age Factors; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000453:epidemiology; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D011013:Pneumonectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
keywords: Atrial fibrillation, Flutter; Epidemiology; Lung cancer surgery; Statistics, risk analysis/modelling