Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality
Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality
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DOI：
10.1016/s0022-5223(03)00974-7
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发表时间：
2003-10-01
影响因子：
6
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Murthy, SC;Law, S;Wong, J
目的：20%~25%的癌症食道切除术后房颤患者术后并发房颤的恢复。本研究的目的是为了了解这一现象。方法：1982-2000年间，198例(22%)食道切除术后患者发生了房颤。使用倾向评分和贪婪匹配算法来开发用于统计比较的对照患者队列。结果：房颤组患者肺部并发症发生率为42%，对照组为17%(P<；.001)。房颤组吻合口瘘发生率较高(6.9%比1.4%，P=0.035)。外科脓毒症伴房颤迁移的频率是对照组的4倍(P=.001)。多因素分析显示，术后肺部并发症(优势比2.5；95%可信区间1.42~4.3)和外科脓毒症(优势比3.4；95%可信区间1.2~9.6)与术后心房颤动有关。房颤组和对照组的死亡率分别为23%和6.3%(P<；.001)。不包括住院死亡的中位生存期在14.5个月(房颤组)和16.9个月(对照组；P=0.4)时没有差异。结论：房颤是食道切除术后手术发病率和死亡率的替代指标。食道切除术后房颤的发生，不仅应该促使对心律失常的适当处理，而且还应该寻找更不祥的潜在原因。
Objective: Postoperative atrial fibrillation complicates recovery in 20% to 25% of patients after esophagectomy for cancer. The purpose of this study is to understand this phenomenon.Methods: Between 1982 and 2000, 198 (22% of 921) patients had postoperative atrial fibrillation after esophagectomy. Propensity scoring and the Greedy Match algorithm were used to develop a cohort of control patients for statistical comparisons. One hundred forty-four patients who had postoperative atrial fibrillation were matched.Results: Pulmonary complications affected 42% of patients in the atrial fibrillation group compared with 17% in the control group (P < .001). Anastomotic leakage was more common in the atrial fibrillation group (6.9% vs 1.4%, P = .035). Surgical sepsis migrated with atrial fibrillation 4 times more frequently (P = .001). Multivariate analysis demonstrated that postoperative pulmonary complications (odds ratio, 2.5; 95% confidence interval, 1.42-4.3) and surgical sepsis (odds ratio, 3.4; 95% confidence interval, 1.2-9.6) were associated with postoperative atrial fibrillation. The mortality rates of the atrial fibrillation and control groups were 23% and 6.3%, respectively (P < .001). Median survival, excluding hospital deaths, was not different at 14.5 months (atrial fibrillation group) and 16.9 months (control group; P = .4).Conclusion: Atrial fibrillation is a surrogate for surgical morbidity and mortality after esophagectomy. The occurrence of atrial fibrillation after esophageal resection should prompt not only the appropriate management of the arrhythmia but also a search for a more ominous underlying cause.