Transient atrial fibrillation after open abdominal aortic revascularization surgery is associated with increased length of stay, mortality, and readmission rates

• Published in: Journal of vascular surgery 2017-08, Vol.66 (2), p.413-422
• Main Authors: Blanco, Barbara A., MD, Kothari, Anai N., MD, Halandras, Pegge M., MD, Blackwell, Robert H., MD, Graunke, Dawn M., PhD, Kuo, Paul C., MD, MBA, Cho, Jae S., MD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aortic Diseases - diagnostic imaging; Aortic Diseases - mortality; Aortic Diseases - surgery; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - mortality; Atrial Fibrillation - therapy; California - epidemiology; Chi-Square Distribution; Comorbidity; Databases, Factual; Female; Florida - epidemiology; Humans; Incidence; Kaplan-Meier Estimate; Length of Stay; Linear Models; Logistic Models; Male; Middle Aged; Multivariate Analysis; Patient Readmission; Proportional Hazards Models; Risk Assessment; Risk Factors; Surgery; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.11.036

Abstract Background It is well established that transient postoperative atrial fibrillation (TPAF) is associated with adverse postoperative outcomes after major cardiac and noncardiac operations. The purpose of this study was to elucidate the incidence, impact, and risk factors associated with the development of TPAF in patients undergoing revascularization surgery for occlusive diseases of the abdominal aorta and its branches (AAB). Methods By use of the Healthcare Cost and Utilization Project State Inpatient Database from Florida and California, patients who underwent open revascularization of AAB between 2006 and 2011 were identified. Patients diagnosed with aortic dissection or abdominal aortic aneurysm were excluded to limit the study cohort to include only patients with occlusive etiology. Also excluded were those with a pre-existing diagnosis of atrial fibrillation and those who underwent thoracic aortic repair and peripheral artery revascularization procedures. Multivariable logistic and linear regression analyses with treatment effects were conducted to analyze the association between TPAF and length of stay (LOS); the mortality rates at index admission, 1 month, and 1 year; and the readmission rates at 1 month and 1 year (adjusted for comorbidities and surgical and demographic factors). A backwards stepwise logistic regression model was built to identify predictors of TPAF. Results A total of 4462 patients were identified; 3253 underwent aortoiliac/femoral bypasses (72.9%), 1514 endarterectomies of AAB (33.9%), and 288 bypasses of AAB (6.5%). The incidence of TPAF was 2.4% (109 patients). Multivariate regression analysis with treatment effects showed that TPAF was associated with significantly increased LOS, mortality, and readmission rates. Factors identified as predictors of TPAF by backwards stepwise logistic regression modeling include electrolyte disorders, increasing age, and Charlson Comorbidity Index (C statistic = .69; accuracy = 58%). Conclusions TPAF after revascularization of AAB is associated with increased LOS, inpatient mortality, 1-year mortality, and hospital readmissions. Strategies to identify patients at risk for development of TPAF and implementation of appropriate prophylactic measures may improve surgical outcomes and reduce cost of care.