Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery.
Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery.
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DOI：
10.1016/j.ahj.2012.09.004
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发表时间：
2012-12
影响因子：
4.8
通讯作者：
Auerbach, Andrew
中科院分区：
文献类型：
--
作者：
Bhave, Prashant D.;Goldman, L. Elizabeth;Vittinghoff, Eric;Maselli, Judith;Auerbach, Andrew
虽然非心脏手术很常见，但很少有大规模研究检查该人群术后房颤（POAF）的发生率和后果。我们试图确定POAF的发生率及其对重大非心脏手术后结局的影响。使用管理数据，我们回顾性分析了在美国375家医院接受1年以上重大非心脏手术的成人的住院过程。具有临床意义的POAF定义为住院期间发生的需要治疗的房颤。在370447例患者中，10957例（3.0%）在住院期间发生了具有临床意义的POAF。在POAF患者中，7355例（67%）似乎有既存房颤，3602例（33%）有新诊断的房颤。黑人患者发生POAF的风险较低（校正比值比，0.53; 95%CI，0.48 - 0.59; P <0.001）。POAF患者的死亡率较高（校正比值比，1.72; 95% CI，1.59至1.86; P <0.001），住院时间明显延长（调整后的相对差异，+24.0%; 95%置信区间[CI]，+21.5%至+26.5%; P <0.001），以及更高的成本（调整后的差异，+$4177; 95%CI，+$3764至+$4590; P <0.001）。POAF是既存房颤的复发还是新诊断，这些结果无差异。非心脏手术后的POAF并不罕见，并且与死亡率和成本增加相关。我们的研究确定了POAF的危险因素，其中似乎包括种族。不仅需要预防新的POAF，还需要改善对既存房颤患者的管理。
Although major non-cardiac surgery is common, few large-scale studies have examined the incidence and consequences of post-operative atrial fibrillation (POAF) in this population. We sought to define the incidence of POAF and its impact on outcomes after major non-cardiac surgery. Using administrative data, we retrospectively reviewed the hospital course of adults who underwent major non-cardiac surgery at 375 US hospitals over a 1-year period. Clinically significant POAF was defined as atrial fibrillation occurring during hospitalization that necessitated therapy. Of 370447 patients, 10957 (3.0%) developed clinically significant POAF while hospitalized. Of patients with POAF, 7355 (67%) appeared to have pre-existing atrial fibrillation and 3602 (33%) had newly diagnosed atrial fibrillation. Black patients had a lower risk of POAF (Adjusted Odds Ratio, 0.53; 95% CI, 0.48 to 0.59; P<0.001). Patients with POAF had higher mortality (Adjusted Odds Ratio, 1.72; 95% CI, 1.59 to 1.86; P<0.001), markedly longer length of stay (Adjusted Relative Difference, +24.0%; 95% Confidence Interval [CI], +21.5% to +26.5%; P<0.001), and higher costs (Adjusted Difference, +$4177; 95% CI, +$3764 to + $4590; P<0.001). These findings did not differ by whether POAF was a recurrence of pre-existing atrial fibrillation, or a new diagnosis. POAF following non-cardiac surgery is not uncommon and is associated with increased mortality and cost. Our study identifies risk factors for POAF, which appear to include race. Strategies are needed to not only prevent new POAF, but also improve management of patients with pre-existing atrial fibrillation.
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影响因子：
39.2
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通讯作者：
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