Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: Analysis of 2588 patients
Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: Analysis of 2588 patients
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DOI：
10.1016/j.jtcvs.2003.07.011
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发表时间：
2004-03-01
影响因子：
6
通讯作者：
Putnam, JB
中科院分区：
文献类型：
--
作者：
Vaporciyan, AA;Correa, AM;Putnam, JB
目的：本研究的目的是确定与心房颤动的发病相关的危险因素，胸外科手术后，让更有针对性的干预措施，在患者中的最高risk.Methods：一个全面的前瞻性数据库被用来确定从1998年1月1日，通过2002年12月31日接受重大胸外科手术的患者。在联系点进行数据收集：术前评估、手术时间、出院和术后访视。所有接受肺、食管、胸壁或纵隔肿块切除术的患者均纳入本研究。结果：2588例房颤患者中，有2588例发生心房颤动，其中1000例发生房颤，1000例发生房颤。符合入选标准。房颤的总发生率为12.3%（n = 319）。疾病类别为原发性肺癌、肺转移、食管癌、胸内转移、良性肺病、其他纵隔肿瘤、间皮瘤、胸壁肿瘤、良性食管和“其他”。“房颤患者的平均住院时间、死亡率和平均住院费用增加。单变量分析评价了年龄、性别、疾病类别、合并症、术前治疗和手术，重要变量进入多变量分析。重要变量（相对危险度; 95%可信区间）为男性（1.72; 1.29-2.28），年龄50 - 59岁（1.70; 1.01-2.88），年龄60 - 69岁（4.49; 2.79-7.22），年龄70岁或以上（5.30; 3.28-8.59），充血性心力衰竭病史（2.51; 1.06-6.24），心律失常病史（1.92; 1.22-3.02），外周血管疾病史（1.65; 0.93-2.92），纵隔肿瘤切除或胸腺切除（2.36; 0.95-5.88），肺叶切除术（3.89; 2.19-6.91），双叶切除术（7.16; 3.02-16.96），肺切除术（8.91; 4.59-17.28），食管切除术（2.95; 1.55-5.62），术中输血（1.39; 0.98-1.98）。结论：多因素分析确定的显著变量与房颤的发生有关。在选定的人群中进行预防性治疗可能会降低房颤的发生率。
Objective: The purpose of this study was to identify risk factors associated with the onset of atrial fibrillation after thoracic surgery to allow more targeted interventions in patients with the highest risk.Methods: A comprehensive prospective database was used to identify patients undergoing major thoracic surgery from January 1, 1998, through December 31, 2002. Data collection was performed at point of contact: at preoperative evaluation, the time of the operation, discharge, and postoperative visits. All patients undergoing resection of a lung, the esophagus, the chest wall, or a mediastinal mass were included in this study. Univariate and multivariate analyses of factors associated with the development of atrial fibrillation were analyzed.Results: There were 2588 patients who. met the inclusion criteria. The overall incidence of atrial fibrillation was 12.3% (n = 319). Categories of disease were primary lung cancer, pulmonary metastasis, esophageal cancer, intrathoracic metastasis, benign lung disease, other mediastinal tumors, mesothelioma, chest wall tumors, benign esophagus, and "other." Patients with atrial fibrillation had increased mean lengths of hospital stay, mortality rates, and mean hospital charges. Univariate analysis evaluated age, sex, disease category, comorbidities, preoperative therapy, and procedure, and significant variables were entered into the multivariate analysis. Significant variables (relative risk; 95% confidence interval) in the multivariate analysis were male sex (1.72; 1.29-2.28), age 50 to 59 years (1.70; 1.01-2.88), age 60 to 69 years (4.49; 2.79-7.22), age 70 years or greater (5.30; 3.28-8.59), history of congestive heart failure (2.51; 1.06-6.24), history of arrhythmias (1.92; 1.22-3.02), history of peripheral vascular disease (1.65; 0.93-2.92), resection of mediastinal tumor or thymectomy (2.36; 0.95-5.88), lobectomy (3.89; 2.19-6.91), bilobectomy (7.16; 3.02-16.96), pneumonectomy (8.91; 4.59-17.28), esophagectomy (2.95; 1.55-5.62), and intraoperative transfusions (1.39; 0.98-1.98).Conclusions: The significant variables identified by means of multivariate analysis were associated with the occurrence of atrial fibrillation. Preventive therapies in selected populations might reduce the incidence of atrial fibrillation.