title: Postoperative atrial fibrillation after thoracic aortic surgery.
abstract: BACKGROUND
  Postoperative atrial fibrillation (POAF) increases considerably the chances of morbidity and mortality after cardiac surgery. The objective of this study was to identify the major risk factors responsible for POAF after thoracic aortic surgery in order to define preventive measures.
  
  
  METHODS
  We analyzed 12,260 records (between January 1, 2004, and December 31, 2008) obtained from the Japan Adult Cardiovascular Surgery Database. Patients with history of AF were excluded. Data were collected for 12 preoperative and 10 operative risk factors that had been proven or believed to influence POAF. The relationship between the risk factors and outcome was assessed by the Fisher exact test, Student t test, and multiple logistic regression analysis.
  
  
  RESULTS
  The patients' mean age (± standard deviation) was 67.5 ± 12.7 years, and 27% of the subjects were women. The incidence of POAF was 17.1%. The following risk factors were associated with increased POAF: age (p < 0.0001), history of smoking (p < = 0.020), hypertension (p = 0.020), congestive heart failure (p < 0.0001), urgent operation (p = 0.023), and concomitant with nonelective coronary artery bypass (p = 0.022). Postoperative mortality and postoperative stroke were significantly increased in patients with POAF (p < 0.0001 in both cases). The odds ratios for the POAF risk factors were as follows: replacement of the ascending aorta, 1.67; aortic arch, 1.62; aortic root, 1.42; concomitant with valve operation, 1.35; age, 1.27; and urgent operation, 1.22.
  
  
  CONCLUSIONS
  Several risk factors contribute to the incidence of POAF after thoracic aortic surgery. We found that POAF significantly increased 30-day operative mortality (p < 0.0001). Our findings can be used to develop a risk stratification system for the prediction of POAF.
authors.affiliation: Department of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan. Electronic address: sutohmiwa@gmail.com.
authors.forename: Miwa
authors.initials: M
authors.lastname: Arakawa
authors.affiliation: Department of Healthcare Quality Assessment Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Cardiovascular Surgery, Tsuchiya General Hospital, Hirosima, Japan.
authors.forename: Naomichi
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Department of Healthcare Quality Assessment Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.affiliation: Department of Cardiovascular Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Katayama
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Department of Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
authors.affiliation: Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D019616:Thoracic Surgical Procedures