Faculty Collaboration Database

Transient atrial fibrillation after open abdominal aortic revascularization surgery is associated with increased length of stay, mortality, and readmission rates. J Vasc Surg 2017 Aug;66(2):413-422

Date

02/14/2017

Pubmed ID

28190713

DOI

10.1016/j.jvs.2016.11.036

Scopus ID

2-s2.0-85012921597 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: It is well established that transient postoperative atrial fibrillation (TPAF) is associated with adverse postoperative outcomes after major cardiac and noncardiac operations. The purpose of this study was to elucidate the incidence, impact, and risk factors associated with the development of TPAF in patients undergoing revascularization surgery for occlusive diseases of the abdominal aorta and its branches (AAB).

METHODS: By use of the Healthcare Cost and Utilization Project State Inpatient Database from Florida and California, patients who underwent open revascularization of AAB between 2006 and 2011 were identified. Patients diagnosed with aortic dissection or abdominal aortic aneurysm were excluded to limit the study cohort to include only patients with occlusive etiology. Also excluded were those with a pre-existing diagnosis of atrial fibrillation and those who underwent thoracic aortic repair and peripheral artery revascularization procedures. Multivariable logistic and linear regression analyses with treatment effects were conducted to analyze the association between TPAF and length of stay (LOS); the mortality rates at index admission, 1 month, and 1 year; and the readmission rates at 1 month and 1 year (adjusted for comorbidities and surgical and demographic factors). A backwards stepwise logistic regression model was built to identify predictors of TPAF.

RESULTS: A total of 4462 patients were identified; 3253 underwent aortoiliac/femoral bypasses (72.9%), 1514 endarterectomies of AAB (33.9%), and 288 bypasses of AAB (6.5%). The incidence of TPAF was 2.4% (109 patients). Multivariate regression analysis with treatment effects showed that TPAF was associated with significantly increased LOS, mortality, and readmission rates. Factors identified as predictors of TPAF by backwards stepwise logistic regression modeling include electrolyte disorders, increasing age, and Charlson Comorbidity Index (C statistic = .69; accuracy = 58%).

CONCLUSIONS: TPAF after revascularization of AAB is associated with increased LOS, inpatient mortality, 1-year mortality, and hospital readmissions. Strategies to identify patients at risk for development of TPAF and implementation of appropriate prophylactic measures may improve surgical outcomes and reduce cost of care.

Author List

Blanco BA, Kothari AN, Halandras PM, Blackwell RH, Graunke DM, Kuo PC, Cho JS

Author

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Aorta, Abdominal
Aortic Diseases
Atrial Fibrillation
California
Chi-Square Distribution
Comorbidity
Databases, Factual
Female
Florida
Humans
Incidence
Kaplan-Meier Estimate
Length of Stay
Linear Models
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Readmission
Proportional Hazards Models
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures