Impact of atrial fibrillation on in-hospital outcomes among hospitalizations for cardiac surgery: an analysis of the National Inpatient Sample

2022 ◽  
pp. jim-2021-001864
Author(s):  
Kanishk Agnihotri ◽  
Paris Charilaou ◽  
Dinesh Voruganti ◽  
Kulothungan Gunasekaran ◽  
Jawahar Mehta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Valve Replacement ◽  
Failure Time ◽  
Artery Bypass ◽  
Bypass Graft ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Hospitalization Costs ◽  
The Impact

The short-term impact of atrial fibrillation (AF) on cardiac surgery hospitalizations has been previously reported in cohorts of various sizes, but results have been variable. Using the 2005–2014 National Inpatient Sample, we identified all adult hospitalizations for cardiac surgery using the International Classification of Diseases, Ninth Revision, Clinical Modification as any procedure code and AF as any diagnosis code. We estimated the impact of AF on inpatient mortality, length of stay (LOS), and cost of hospitalization using survey-weighted, multivariable logistic, accelerated failure-time log-normal, and log-transformed linear regressions, respectively. Additionally, we exact-matched AF to non-AF hospitalizations on various confounders for the same outcomes. A total of 1,269,414 hospitalizations were noted for cardiac surgery during the study period. Coexistent AF was found in 44.9% of these hospitalizations. Overall mean age was 65.6 years, 40.9% were female, mean LOS was 11.6 days, and inpatient mortality was 4.5%. Stroke rate was lower in AF hospitalizations (1.8% vs 2.1%, p<0.001). Mortality was lower in the AF (3.9%) versus the non-AF (5%) group (exact-matched OR or emOR=0.48, 95% CI 0.29 to 0.80, p<0.001; 987 matched pairs, n=2423), with similar results after procedural stratification: isolated valve replacement/repair (emOR=0.38, p<0.001), isolated coronary artery bypass graft (CABG) (emOR=0.33, p<0.001), and CABG with valve replacement/repair (emOR=0.55, p<0.001). A 12% increase was seen in LOS in the AF subgroup (exact-matched time ratio=1.12, 95% CI 1.10 to 1.14, p<0.001) among hospitalizations which underwent valve replacement/repair with or without CABG. Hospitalizations for cardiac surgery which had coexistent AF were found to have lower inpatient mortality risk and stroke prevalence but higher LOS and hospitalization costs compared with hospitalizations without AF.

Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Karol Quelal ◽  
Olakanmi Olagoke ◽  
Jose Baez
Keyword(s):  
Cardiac Surgery ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Hospital Death ◽  
National Inpatient Sample ◽  
Permanent Pacemaker Implantation

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p < 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

The Impact of Postoperative Atrial Fibrillation on Neurocognitive Outcome After Coronary Artery Bypass Graft Surgery

2002 ◽  
Vol 94 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Timothy O. Stanley ◽  
G. Burkhard Mackensen ◽  
Hilary P. Grocott ◽  
William D. White ◽  
James A. Blumenthal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Atrial Fibrillation ◽  
Artery Bypass Graft ◽  
Neurocognitive Outcome ◽  
The Impact

scholarly journals Preoperative Atrial Fibrillation is associated with long-term morTality in patients undergoing suRgical AortiC valvE Replacement

2021 ◽  
Author(s):  
Mohamed Farag ◽  
Yusuf Kiberu ◽  
Ashwin Reddy ◽  
Ahmad Shoaib ◽  
Mohaned Egred ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Term Survival ◽  
The Impact ◽  
Long Term Mortality

Introduction Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). Methods We performed a retrospective, single-centre study involving 2,628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/ 2,628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. Results Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; HR: 2.24, 95% CI: 1.79-2.79, P<0.001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, P<0.001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, P=0.03) compared with the SR cohort. Conclusions Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.

The Impact of Postoperative Atrial Fibrillation on Neurocognitive Outcome After Coronary Artery Bypass Graft Surgery

2002 ◽  
Vol 94 (2) ◽  
pp. 290-295
Author(s):  
Timothy O. Stanley ◽  
G. Burkhard Mackensen ◽  
Hilary P. Grocott ◽  
William D. White ◽  
James A. Blumenthal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Atrial Fibrillation ◽  
Artery Bypass Graft ◽  
Neurocognitive Outcome ◽  
The Impact

Perioperative Beta-Blocker for Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

2020 ◽  
Author(s):  
Sue Hyun Kim ◽  
Myoung-jin Jang ◽  
Ho Young Hwang
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Beta Blocker ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Randomized Controlled ◽  
Online Databases ◽  
The Impact

Abstract Background This meta-analysis was conducted to evaluate the impact of perioperative use of beta-blocker (BB) on postoperative atrial fibrillation (POAF) after cardiac surgery other than isolated coronary artery bypass grafting (CABG). Methods Five online databases were searched. Studies were included if they (1) enrolled patients who underwent cardiac surgery other than isolated CABG and (2) demonstrated the impact of perioperative use of BB on POAF based on the randomized controlled trial or adjusted analysis. The primary outcome was the occurrence rates of POAF after cardiac surgery. A meta-regression and subgroup analysis were performed according to the proportion of patients with cardiac surgery other than isolated CABG and the timing of BB use, respectively. Results Thirteen articles (5 randomized and 8 nonrandomized studies: n = 25,496) were selected. Proportion of enrolled patients undergoing cardiac surgery other than isolated CABG ranged from 7 to 100%. The BBs were used in preoperative, postoperative, and both periods in 5, 5, and 3 studies, respectively. The pooled analyses showed that the risk of POAF was significantly lower in patients with perioperative BB than those without (odds ratio, 95% confidence interval = 0.56, 0.35–0.91 and 0.70, 0.55–0.91 in randomized and nonrandomized studies, respectively). The risk of POAF was lower in the BB group irrespective of the proportion of nonisolated CABG. Benefit regarding in-hospital mortality was inconclusive. Perioperative stroke and length of stay were not significantly different between BB and non-BB groups. Conclusions Perioperative use of BB is effective in preventing POAF even in patients undergoing cardiac surgery other than isolated CABG, although it did not translate into improved clinical outcomes.

scholarly journals POST-OPERATIVE ATRIAL FIBRILLATION

2015 ◽  
Vol 22 (11) ◽  
pp. 1438-1442
Author(s):  
Ghulam Hussain ◽  
Naseem Ahmad ◽  
Sara Zaheer ◽  
Mirza Ahmad Raza Baig
Keyword(s):  
Atrial Fibrillation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hemodynamic Instability ◽  
Study Data ◽  
P Value ◽  
Exact Test ◽  
Post Operative Atrial Fibrillation ◽  
Increased Risk ◽  
The Impact

Atrial fibrillation is the most common arrhythmia observed following CoronaryArtery Bypass Graft surgery. Objectives: To determine the incidence of post-operative atrialfibrillation in patients undergoing coronary artery bypass grafting. Materials and Methods:Study Design: Non-randomized prospective. Setting: Cardiac Surgery Department ofMultan Institute of Cardiology, Multan. Period: 20-1-2014 to 01-05-2015. A total number offour hundred and ninety (490) patients having age more than 40 years undergoing isolatedcoronary artery bypass graft surgery were included in the study. Data was analyzed in SPSSV20 software. Frequency and percentages were used for Atrial Fibrillation. To see the impact ofAF on morbidity, patients developing AF was compared with those who do not develop AtrialFibrillation post-operatively using independent sample t-test for quantitative variables. Chisquaretest and Fischer’s Exact test (whenever appropriate) was used to compare qualitativevariables. Results: A total number of four hundred and ninety (490) patients were included inthis study. There were more 431 males (88.0%) in this study. of the patients 71.6% were in LVGrade I before surgery. Incidence of post-operative atrial fibrillation was 13.5%. In 4.5% patientsIABP was inserted due to hemodynamic instability. Ventilation time and hospital stay time wassignificantly higher in patients with AF postoperatively (p value 0.03 and 0.02 respectively).But duration of inotropic support, post-op CKMB levels and IABP use were not significantlydifferent in both groups. Conclusion: The incidence of post-operative Atrial Fibrillation is 13.5%according to this study. And these patients were associated with increased risk of morbidity.

Abstract 16236: Hyperthyroidism Does Not Negatively Impact the Outcomes of Patients Admitted for Atrial Fibrillation: Analysis of the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hafeez Shaka ◽  
Emmanuel Akuna ◽  
Iriagbonse Asemota ◽  
Ehizogie Edigin ◽  
Precious O Eseaton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Linear Regression Analysis ◽  
The United States ◽  
Hospital Length ◽  
Electrical Cardioversion ◽  
Hospital Length Of Stay ◽  
Secondary Diagnosis ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
The Impact

Introduction: Hyperthyroidism is a well-established risk factor for developing Atrial fibrillation (AF). The impact of hyperthyroidism in patients admitted for AF is unclear. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of hyperthyroidism. Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS is the largest inpatient hospitalization database in the United States (US). The NIS was searched for hospitalization of adult patients with AF as a principal diagnosis with and without hyperthyroidism as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were hospital length of stay (LOS), rate of ablation and electrical cardioversion. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,629 AF hospitalizations, 1.8% had hyperthyroidism. Hospitalization for AF with hyperthyroidism had similar inpatient mortality (0.5% vs 0.9%, AOR 0.61, CI 0.36-1.04, P=0.069), longer LOS (3.6 vs 3.4 days, p<0.0001), with lower rates of ablation (2.8% vs 4.2%, AOR 0.62, CI 0.49-0.78, P<0.0001) and electrical cardioversion (14.6% vs 17.6%, AOR 0.82, CI 0.73-0.91, P<0.0001) compared to those without hyperthyroidism. Conclusion: Hospitalizations for AF with hyperthyroidism had similar inpatient mortality, decreased LOS and less rates of ablation and electrical cardioversion compared to those without hyperthyroidism. Although, hyperthyroidism increases the risk of AF, hyperthyroidism does not negatively impact outcomes of patients admitted for AF based on US national hospital billing database.

Abstract 132: Association Between Perioperative Amiodarone and Postoperative Atrial Fibrillation Following Cardiac Surgery

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Auras R Atreya ◽  
Aruna Priya ◽  
Mihaela S Stefan ◽  
Quinn R Pack ◽  
Tara Lagu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Ventricular Arrhythmias ◽  
Artery Bypass ◽  
Postoperative Atrial Fibrillation ◽  
Randomized Controlled Studies ◽  
Hospitalization Costs

Background: Amiodarone effectively reduces the incidence of postoperative atrial fibrillation (POAF) in randomized trials and guidelines give a Class IIa recommendation for its use in high risk patients to improve outcomes; but little is known about its effectiveness to prevent POAF in routine clinical practice. Our aim was to determine the association between perioperative amiodarone use and clinical outcomes in a real-world cohort. Methods: We identified patients aged ≥18 years without atrial fibrillation at baseline, who underwent elective coronary artery bypass surgery ± heart valve surgery in a hospital that contributed to PREMIER, Inc. data warehouse during 2013-2014. We excluded patients to replicate patients enrolled in prior randomized controlled studies. Perioperative amiodarone use was defined as receipt of amiodarone on the day of surgery or prior to surgery within the same hospitalization. We used propensity scores to match patients who received perioperative amiodarone to patients who did not, and compared outcomes. Our primary outcome was POAF (not present on admission). Secondary outcomes included in-hospital mortality, 1 month-readmission among survivors, length of stay and cost. Results: We examined 12,758 patients free of AF admitted at 235 hospitals, of which 2191 (17%) were treated with perioperative amiodarone. Baseline characteristics were well matched after propensity scoring. (Table 1) After adjustment, receipt of amiodarone was associated with reduction in POAF in the matched cohort (ARR 5.6%; RR 0.83, 95% CI 0.75-0.92) but was associated with greater risk of ventricular arrhythmias (OR: 1.66, 95% CI: 1.20 - 2.29), cardiogenic shock (OR: 1.66, 95% CI: 1.13 - 2.42) and higher hospitalization costs ($1,159, 95% CI: $373 - $1,946). There were no differences in in-hospital mortality, length of stay, 1 month readmission. Conclusions: In this large cohort of propensity matched patients undergoing elective cardiac surgery, perioperative amiodarone use was associated with a modest reduction in POAF, but there was no significant relationship with mortality, length of stay, or 1 month readmission. However, we found a small increase in risk of ventricular arrhythmias, cardiogenic shock and costs; findings that have not previously been described and require further evaluation.

scholarly journals Pleural effusion in patients undergoing coronary artery bypass graft and valve replacement: a population study

2018 ◽  
Vol 4 (3) ◽  
pp. 167
Author(s):  
Maria Rossolatou ◽  
Dimitris Papageorgiou ◽  
Georgia Toylia ◽  
Georgios Vasilopoulos
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Pleural Effusion ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Valve Surgery ◽  
Artery Bypass Graft

Introduction: The postoperative pleural effusion (PE) is common in patients who undergo cardiac surgery. Most of these effusions develop as a consequence of the surgical procedure itself and follow a generally benign course. The characteristics of PE and the factors predisposing factors should be documented further.Aim: The aim of this study was to determine the prevalence of PE after cardiac surgery. And also to determine whether this prevale is related to the type of cardiac surgery.Material and Methods: This retrospective study was conducted at a large private hospital in Athens. The sample of the study was all adult patients who undergo coronary artery bypass graft (CABG), valve replacement or a combination of these surgeries. A special form was made to record patients’ demographic and clinical data. Descriptive statistics and correlation studies were performed with the SPSS 22.0, at significant level a=0.05.Results: Among the 118 patients, who included in this study, 42.4% underwent CABG surgery, 29.7% valve surgery, and 28% a combination of two types of surgery. Postoperative pleural effusion was developed in 40% of those who underwent CABG, 42.9% of those who underwent cardiac valve surgery, and 42.4% of those who underwent in both types of surgeries. The mean time development of PE was 6.65 days for the CABG group, 4.8 days for the valve group and 8.7 days for the CABG +valve group. There was no statistically significant difference in the demographic and clinical data of patients with pleural effusion according the type of cardiac surgery.Conclusions: Postoperative PE is a common complication at cardiac surgery and is more common in patients undergoing surgical recuperation of valve.

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