Resident physician Université de Montréal Montréal, Quebec, Canada
Background: Postoperative atrial fibrillation (POAF) is a common complication after thoracic surgery, affecting patient outcomes and healthcare due to longer stays, extra treatments, and related complications. Several studies have examined the financial burden of POAF, but it is unclear if it independently affects hospital costs or is just a marker of sicker patients with costly complications. Most data come from private payer models. This study aims to determine the independent financial burden of POAF in a public healthcare system.
METHODS AND RESULTS: We analyzed 655 patients who underwent major non-transplant thoracic surgery at our center between April 2019 and March 2020, excluding those not in sinus rhythm on surgery day. Hospitalization costs in CAD$, excluding physician reimbursement, were calculated for each patient. Increased cost was defined as costs at or above the 75th percentile. Procedures were analyzed as categorical variables with multiple options, using lobectomy as the reference group. Potential predictors of increased costs were explored in multivariable logistic regression. Multivariate linear model was used to assess the independent cost of POAF.
The mean hospitalization cost was $15,706 (SD $ 19,553), with a 75th percentile of $ 16,027, and 60 patients (9.2%) experiencing POAF. Multivariate analysis showed male sex (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.0), chronic obstructive pulmonary disease (OR 2.7, 95% CI 1.6-4.6), and hemoglobin below 10 g/dL (OR 3.9, 95% CI 1.3-12.0) were linked to higher costs. Esophagectomy was also a predictor compared to lobectomy (OR 13.0, 95% CI 6.6-25.9). POAF was associated with increased cost (OR 4.9, 95% CI 2.4-10.2), with an independent increase in mean cost of $4,922 (SD $2,377). Other predictors found to be significantly associated with increased costs were postoperative acute kidney injury (OR 3.3, 95% CI 1.2-9.7), air leak (OR 5.4, 95% CI 2.7-10.8), POAF, and pneumonia (OR 13.1, 95% CI 5.9-29.1).
Conclusion: POAF is an independent predictor of higher hospitalization costs (5-fold increased odds) and is linked to a cost increase of $3,672 following thoracic surgery. This underscores the need to better predict and prevent POAF and reduce its burden on the healthcare system. The study also identifies other predictors of increased costs that may be amenable to intervention.
