Association of Postoperative Atrial Fibrillation Duration after Coronary Artery Bypass Grafting with Poor Postoperative Outcomes

TL;DR

Longer postoperative atrial fibrillation after heart surgery is linked to worse recovery outcomes like breathing and kidney issues, but not higher death rates.

Contribution

This study identifies prolonged postoperative atrial fibrillation as an independent risk factor for specific postoperative complications after CABG surgery.

Findings

POAF durations ≥48 hours were associated with increased acute respiratory failure, kidney injury, and gastrointestinal bleeding.

Prolonged POAF also correlated with longer hospital and ICU stays.

No significant link was found between POAF duration and in-hospital mortality or stroke.

Abstract

Postoperative atrial fibrillation (POAF) has long been
associated with poor perioperative outcomes after coronary artery bypass grafting
(CABG). In this study, we aimed to investigate the effect of prolonged POAF
durations on perioperative outcomes of CABG.

This retrospective
cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from
January 2018 to September 2021. We compared patients with POAF durations
≥48 hours to patients with POAF durations <48 hours. Primary outcomes
were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney
injury (AKI), and significant gastrointestinal bleeding (GIB); secondary outcomes
were postoperative length of stay (LOS) and intensive care unit (ICU) duration.
Associations between primary outcomes and POAF duration were determined using
logistic regression and restricted cubic spline analyses. Differences in baseline
characteristics were controlled using propensity score matching (PSM) and inverse
probability of treatment weighting (IPTW).

Out of 11,848 CABG
patients, 3604 (30.4%) had POAF, while 1131 (31.4%) had it for a duration of
≥48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval
[CI]: 1.47–6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42–3.99), and significant
GIB (adjusted OR: 2.60, 95% CI: 1.38–5.03) were associated with POAF durations
≥48 hours; however, neither in-hospital mortality (adjusted OR: 1.60, 95%
CI: 0.97–2.65) nor stroke (adjusted OR: 1.28, 95% CI: 0.71–2.34) was. These
results remained even following PSM and IPTW analyses.

POAF
durations longer than 48 hours were independently associated with poorer
perioperative recovery from CABG, with respect to the occurrence of ARF, AKI, and
GIB, as well as a longer postoperative LOS and ICU duration. However, it was not
associated with greater in-hospital mortality or stroke occurrence. All these
findings suggest that postoperative monitoring of POAF and positive intervention
after detection may be more helpful in optimizing post-CABG patient outcomes.

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