Abstract
Objective
The literature has reported worse in-hospital outcomes for patients with atrial fibrillation.
The objective of the following study is to provide detailed results on the long-term
impact of postoperative atrial fibrillation on survival and hospital readmission in
cardiac surgery.
Methods
All patients undergoing open cardiac surgery were reviewed with the exclusion of preoperative
atrial fibrillation or patients undergoing ventricular assist device, transplant,
or Cox-Maze procedures. Propensity matching (1:1) was performed to ensure similar
baseline characteristics. Multivariable analysis identified significant associations
with mortality and readmission.
Results
A total of 12,227 patients with cardiac disease were divided into 7927 patients (64.8%)
without postoperative atrial fibrillation and 4300 patients (35.2%) with new-onset
postoperative atrial fibrillation. Propensity matching (1:1) yielded 4275 risk-adjusted
pairs. There was no difference between the nonpostoperative atrial fibrillation versus
postoperative atrial fibrillation cohorts regarding operative mortality (4.61% vs
4.12%; P = .26) and stroke (2.32% vs 2.76%; P = .191). Patients with postoperative atrial fibrillation had higher rates of reoperation
(12.12% vs 6.83%; P < .001), transfusion (43.42% vs 36.94%; P < .001), sepsis (1.99% vs 0.80%; P < .001), prolonged ventilation (15.88% vs 9.24% vs; P < .001), pneumonia (6.60% vs 2.36%; P < .001), renal failure (6.90% vs 3.37%; P < .001), and dialysis (4.94% vs 2.08%; P < .001). The postoperative atrial fibrillation cohort had a significantly higher
incidence of atrial fibrillation on follow-up (11.74% vs 4.75%; P < .001). Postoperative atrial fibrillation was independently associated with mortality
(hazard ratio, 1.21; 1.12-1.33; P < .001), all-cause readmissions (hazard ratio, 1.05; 1.01-1.1; P = .010), and heart failure–specific readmission (hazard ratio, 1.14; 1.04-1.26; P = .01).
Conclusions
Patients in the postoperative atrial fibrillation cohort had worse perioperative morbidity,
lower survival, and more readmissions for heart failure on long-term follow-up.
Graphical abstract

Graphical Abstract
Key Words
Abbreviations and Acronyms:
AF (atrial fibrillation), CABG (coronary artery bypass grafting), COPD (chronic obstructive pulmonary disease), HF (heart failure), HR (hazard ratio), POAF (postoperative atrial fibrillation), STS (Society of Thoracic Surgeons)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 31, 2022
Accepted:
October 21,
2021
Received in revised form:
October 20,
2021
Received:
October 17,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
Institutional Review Board approval (STUDY18120143) on April 17, 2019; written consent waived.
Read at the 101st Annual Meeting of The American Association for Thoracic Surgery: A Virtual Learning Experience, April 30-May 2, 2021.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery