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Incidence and Outcomes of Postop Arrhythmia After Upper GI Surgery
Quick Takes
- A high rate of arrhythmic events in patients undergoing esophageal resection with a 17.1% incidence of postoperative AF after elective esophageal surgery was noted.
- Furthermore, new-onset postoperative AF was associated with severe postoperative complications and worse outcomes.
- Additional analysis is needed regarding whether cardiac monitoring for 72 hours and consultation with cardiologists after discharge for patients with postoperative AF and risk factors such as sepsis, infection, emergency surgery, extended surgery, and organ failure would improve clinical outcomes.
Study Questions:
What is the incidence of arrhythmia after upper gastrointestinal (GI) surgery, its risk factors, and its short- and long-term implications for patient outcomes?
Methods:
The investigators conducted a cohort study of 1,210 patients who underwent surgery of the upper GI tract (esophagus, stomach, or pancreas) at the University Medical Center Göttingen in Germany between January 2012–December 2018. Follow-up was performed between February–May 2020. Patients were excluded if they had a pre-existing cardiac arrhythmia or pacemaker. The incidence of atrial fibrillation (AF) was recorded in most cases of postoperative arrhythmia; therefore, the analysis focused on postoperative AF. The authors ascertained the incidence of postoperative AF in the intensive care unit (ICU) after visceral surgery by retrospectively analyzing data from patients who underwent surgical procedures of the upper GI tract, identified possible risk factors for postoperative AF, and investigated the immediate and long-term outcomes of postoperative AF. A multivariable logistic regression model was used to assess associations between surgical complications and postoperative AF occurrence, with odds ratios (ORs) and 95% confidence intervals (CIs) reported.
Results:
A total of 1,210 patients (median [interquartile range] age, 62 [19-90] years; 704 [58.2%] men) were enrolled in this study. Postoperative arrhythmia was recorded in 100 patients (8.3%). Among the different procedures, esophagectomy was associated with the highest incidence of postoperative AF (45.5% in complex esophageal resections and 17.1% in elective thoracoabdominal esophagectomies). The incidence of postoperative AF was associated with prolonged length of stay in the ICU (23.4 days for patients with postoperative AF vs. 5.9 days for those without; p < 0.001). Four factors were associated with the occurrence of postoperative AF: patients’ age (OR, 1.06; 95% CI, 1.03-1.08; p < 0.001), intraoperative surgical complications (OR, 2.47; 95% CI, 1.29-4.74; p = 0.006), infections (OR, 2.23; 95% CI, 1.31-3.80; p = 0.003), and organ failure (OR, 4.01; 95% CI, 2.31-6.99; p < 0.001). In the multivariable analysis, postoperative AF (OR, 7.08; 95% CI, 2.75-18.23; p < 0.001) and sepsis (OR, 10.98; 95% CI, 3.91-30.81; p < 0.001) were associated with in-hospital mortality. At a median 19-month follow-up, 20 of 74 patients (27.0%) with postoperative AF developed recurring episodes of arrhythmia after discharge.
Conclusions:
The authors reported that postoperative AF was associated with an increased length of stay in the ICU and in-hospital mortality in patients after upper GI tract surgery.
Perspective:
This study reports a high rate of arrhythmic events in patients undergoing esophageal resection with a 17.1% incidence of postoperative AF after elective esophageal surgery. Furthermore, new-onset postoperative AF was associated with severe postoperative complications. The present study offers a foundation for future prospective clinical trials to ascertain if standardized preoperative screenings for AF and cardiac workup are useful in patients with planned upper GI surgery, especially in those with a high risk of postoperative AF (e.g., elderly, esophageal or extended surgery in general). Additional analysis is also needed regarding whether cardiac monitoring for at least 72 hours and consultation with cardiologists after discharge for patients with postoperative AF and risk factors such as sepsis, infection, emergency surgery, extended surgery, and organ failure would improve outcomes.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Esophagectomy, Esophagus, General Surgery, Hospital Mortality, Intensive Care Units, Length of Stay, Pancreas, Patient Discharge, Patient Outcome Assessment, Postoperative Complications, Risk Factors, Secondary Prevention, Sepsis, Stomach, Upper Gastrointestinal Tract
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