Perioperative Risk Factors for New-Onset Perioperative Atrial Fibrillation Following Minimally Invasive Esophagectomy: A Single-Center Retrospective Study.

Abstract

Atrial fibrillation (AF) is the most common cardiovascular complication following esophagectomy. The aim of this study was to identify the risk factors for new-onset perioperative (intraoperative and/or postoperative) AF in patients undergoing minimally invasive esophagectomy (MIE). This study used a single-center retrospective design and included 814 patients who were diagnosed with esophageal cancer and underwent McKeown MIE. The patients' characteristics and perioperative data were collected from the electronic medical records and analyzed. New-onset perioperative AF occurred in 5.3% of the patients (43/814), with 4 patients developing intraoperative AF and 39 patients developing postoperative AF. Multivariate logistic regression analysis identified age (odds ratio [OR] 1.081 and p < 0.001), history of coronary heart disease (OR 4.269 and p < 0.001), and intraoperative blood loss (OR 1.004 and p = 0.008) as independent risk factors for perioperative AF following MIE. The area under the receiver operating characteristic curve for the multivariate logistic regression model was 0.735 (95% confidence interval 0.660-0.810). The incidences of postoperative pulmonary complications and anastomotic leakage were significantly higher in patients with perioperative AF than in those without perioperative AF (both p = 0.011). Patients with perioperative AF also had a longer hospital stay (15.0 vs. 13.0 days and p = 0.034). Increasing age, history of coronary heart disease, and intraoperative blood loss were associated with new-onset perioperative AF following MIE. However, the impact of intraoperative blood loss on AF is likely to be of marginal clinical relevance. The observed AF fell below projected estimates, resulting in inadequate statistical power for the study outcomes. Chinese Clinical Trial Registry (No. ChiCTR2300074003; date of registration, 27/07/2023).