The impact of new-onset atrial fibrillation on in-hospital mortality following cardiac surgery.

Abstract

The impact of new-onset postoperative atrial fibrillation (NAF) on in-hospital mortality (IHM) following cardiac surgery is unknown. All patients without preoperative atrial fibrillation undergoing isolated coronary artery bypass graft surgery (CABG) and concomitant CABG and valve surgery were identified (n = 7,347). The association between NAF and IHM was determined using logistic regression modeling. Also, propensity score analysis was used to create two matched subgroups of patients with and without NAF (n = 2,015 in each group). The secondary outcomes examined were stroke, myocardial infarction (MI), intra-aortic balloon pump use, GI complications, deep sternal wound infection (DSWI), septicemia, renal failure, and length of stay. NAF developed in 2,047 patients (27.9%). NAF was not an independent predictor of IHM (odds ratio, 0.8; 95% confidence interval, 0.6 to 1.2; p = 0.3). In multivariate analysis, NAF was associated with age >/= 60 years, combined procedures, preoperative MI within 7 days of surgery, COPD, cerebrovascular disease, and male gender. Propensity-adjusted results revealed no difference in IHM between NAF vs no-NAF patients (2.9% vs 3.5%, respectively; Bonferroni-corrected p = 0.99). However, GI complications (4.2% vs 2.1%), DSWI (1.3% vs 0.4%), septicemia (4.0% vs 1.1%), renal failure (7.6% vs 4.3%), and length of stay (8 days vs 6 days) were significantly increased in patients with NAF. NAF following cardiac surgery is not associated with increased IHM.