title: Postoperative Atrial Fibrillation Predicts Long-Term Cardiovascular Events after Radical Cystectomy.
abstract: OBJECTIVE
  Postoperative atrial fibrillation after radical cystectomy occurs in 2% to 8% of cases. Recent evidence suggests that transient postoperative atrial fibrillation leads to future cardiovascular events. The long-term cardiovascular implications of postoperative atrial fibrillation in patients undergoing radical cystectomy are largely unknown.
  
  
  METHODS
  The Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida were used to identify patients who underwent radical cystectomy between 2007 and 2010. After excluding patients with a history of atrial fibrillation, coronary artery disease and/or stroke, patients were matched using propensity scoring on age, race, insurance status and preexisting comorbidities. Adjusted Kaplan-Meier time-to-event analysis and Cox proportional hazards models were used to assess the effect of postoperative atrial fibrillation on cardiovascular events (acute myocardial infarction and stroke) during postoperative year 1.
  
  
  RESULTS
  Radical cystectomy was performed in 4,345 patients who met the study inclusion criteria, of whom 210 (4.8%) had postoperative atrial fibrillation. There was a significantly higher cumulative incidence of cardiovascular events during the first postoperative year in patients in whom postoperative atrial fibrillation developed (24.8% vs 10.9%, adjusted log rank p=0.007). Cox proportional hazards regression demonstrated an increased risk of cardiovascular events in patients with postoperative atrial fibrillation (HR 10, p=0.02).
  
  
  CONCLUSIONS
  Our results demonstrate that patients undergoing radical cystectomy in whom transient postoperative atrial fibrillation develops are at significantly increased risk for cardiovascular events in the first postoperative year. Physicians should be vigilant in assessing postoperative atrial fibrillation, even when transient, and establish appropriate followup given the increased risk of cardiovascular morbidity.
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinoiss; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois. Electronic address: rblackwell@lumc.edu.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Blackwell
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinoiss.
authors.forename: Chandy
authors.initials: C
authors.lastname: Ellimoottil
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinoiss.
authors.forename: Petar
authors.initials: P
authors.lastname: Bajic
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Anai
authors.initials: A
authors.lastname: Kothari
authors.affiliation: Department of Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Matthew
authors.initials: M
authors.lastname: Zapf
authors.affiliation: Department of Public Health Sciences, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kliethermes
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinoiss; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Flanigan
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinoiss.
authors.forename: Marcus L
authors.initials: ML
authors.lastname: Quek
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinoiss; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; 1:MAP Surgical Analytics Group, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Gopal N
authors.initials: GN
authors.lastname: Gupta
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: atrial fibrillation; cystectomy; myocardial infarction; postoperative complications; stroke