title: Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score.
abstract: BACKGROUND
  Atrial fibrillation (AF) remains the most common complication after cardiac surgery. The present study aim was to derive an effective bedside tool to predict postoperative AF and its related complications.
  
  
  RESULTS
  Data of 17 262 patients undergoing adult cardiac surgery were retrieved at 3 European university hospitals. A risk score for postoperative AF (POAF score) was derived and validated. In the overall series, 4561 patients (26.4%) developed postoperative AF. In the derivation cohort age, chronic obstructive pulmonary disease, emergency operation, preoperative intra-aortic balloon pump, left ventricular ejection fraction <30%, estimated glomerular filtration rate <15 mL/min per m(2) or dialysis, and any heart valve surgery were independent AF predictors. POAF score was calculated by summing weighting points for each independent AF predictor. According to the prediction model, the incidences of postoperative AF in the derivation cohort were 0, 11.1%; 1, 20.1%; 2, 28.7%; and ≥3, 40.9% (P<0.001), and in the validation cohort they were 0, 13.2%; 1, 19.5%; 2, 29.9%; and ≥3, 42.5% (P<0.001). Patients with a POAF score ≥3, compared with those without arrhythmia, revealed an increased risk of hospital mortality (5.5% versus 3.2%, P=0.001), death after the first postoperative day (5.1% versus 2.6%, P<0.001), cerebrovascular accident (7.8% versus 4.2%, P<0.001), acute kidney injury (15.1% versus 7.1%, P<0.001), renal replacement therapy (3.8% versus 1.4%, P<0.001), and length of hospital stay (mean 13.2 versus 10.2 days, P<0.001).
  
  
  CONCLUSIONS
  The POAF score is a simple, accurate bedside tool to predict postoperative AF and its related or accompanying complications.
authors.affiliation: Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Marco
authors.initials: M
authors.lastname: Zanobini
authors.forename: Marzia
authors.initials: M
authors.lastname: Cottini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
authors.forename: Matteo
authors.initials: M
authors.lastname: Saccocci
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D003661:Decision Support Techniques; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: antiarrhythmic prevention; atrial fibrillation; cardiac surgery; risk stratification