Resident physician, Université de Montréal, Quebec, Canada
Background: Post-operative atrial fibrillation (POAF) is a common complication following major thoracic surgery. Although previous studies have linked POAF to longer hospital stays, it remains unclear whether this is directly related to the arrythmia itself or to associated complications and comorbidities. This study aims to evaluate whether POAF is truly an independent predictor of prolonged hospitalization.
METHODS AND RESULTS: We conducted a retrospective analysis of 655 patients who underwent major non-transplant thoracic surgery at our center between April 2019 and March 2020. Patients not in sinus rhythm on the day of surgery were excluded. We assessed preoperative comorbidities and postoperative complications. An increased hospital stay was defined as a duration equal to or exceeding the 75th percentile in our primary analysis. Variables from the univariate analysis with a p-value inferior to 0.1 were included in a multivariate analysis to identify independent predictors of extended hospitalization. A backward stepwise elimination process was used, removing variables with a p-value superior to 0.05.
Sixty patients (9.2%) presented POAF. The median length of stay was five days (IQR 3 to 7). Preoperative predictors of hospital stays longer than 7 days included male sex (OR 1.7, 95% CI 1.1 to 2.7), COPD (OR 2.1, 95% CI 1.3 to 3.5) and pre-surgery hemoglobin levels below 10 g/dL (OR 6.1, 95% CI 1.8 to 20.2). Compared to lobectomy, both esophagectomy (OR 17.0, 95% CI 8.1 to 35.4) and bilobectomy (OR 4.7, 95% CI 1.6 to 14.1) were also strongly linked to extended hospital stays. Post-operative complications independently associated with prolonged stays included POAF (OR 3.2, 95% CI 1.5 to 6.7), acute kidney injury (OR 7.0, 95% CI 2.2 to 22.1), persistent air leak (OR 11.1, 95% CI 5.4 to 22.7) and pneumonia (OR 13.9, 95% CI 5.7 to 34.1). Using the median stay as the cut-off definition for prolonged hospitalization, the independent OR for POAF was 3.9 (95% CI 1.8 to 8.8).
Conclusion: While several factors were stronger predictors of extended hospitalization, this study demonstrates that POAF remains an independent predictor of prolonged hospital stays in this large cohort. This might be particularly impactful for patients with other major complications.
