As many as 12% of patients undergoing major, non-cardiac surgery experience an irregular heartbeat called atrial fibrillation and post-operative atrial fibrillation (POAF) often is dismissed as a transient phenomenon. But a Loyola University Medical Centre study has found that POAF can significantly increase the risk of heart attack or stroke during the first 12 months after surgery.
Among bladder cancer patients who underwent a cystectomy (bladder removal) and developed POAF, 24.8% experienced a heart attack or stroke during the first 12 months after surgery. By comparison, 10.9% of patients who did not experience post-operative atrial fibrillation experienced a heart attack or stroke during the first year.
"Physicians should be vigilant in assessing postoperative atrial fibrillation, even when transient, and establish appropriate follow-up, given the increased risk of cardiovascular morbidity," first author Dr Robert Blackwell, senior author Dr Gopal Gupta and colleagues report.
Atrial fibrillation, also known as A-fib, is an irregular and often rapid heartbeat that can cause poor blood flow to the body. Patients with chronic A-fib are known to be at higher risk for strokes and heart failure. Previous studies have found that post-operative A-fib occurs in between 3% and 12.3% of major, non-cardiac surgeries. The Loyola study is unique in that it examines the association of post-operative A-fib on long-term heart attacks and strokes following a procedure performed completely within the abdomen.
Researchers examined the Healthcare Cost and Utilisation Project State Inpatient Databases for California and Florida to identify patients who underwent radical cystectomies between 2007 and 2010. Patients with prior histories of A-fib, coronary artery disease or stroke were excluded. Of the 4,345 patients who met the inclusion criteria, 210 (4.8%) developed post-operative A-fib.
The study was conducted by Loyola's predictive analytics programme, which mines large data sets to predict health outcomes. In addition to postoperative A-fib, researchers are studying, for example, what factors can improve outcomes of surgeries performed on weekends; how many rectal cancer operations a hospital needs to perform for the best results; and whether having a trauma department confers a beneficial "halo effect" on patient outcomes across the board.
Large new databases, electronic medical records and more powerful computers are enabling researchers to conduct such studies. "We're now able to ask and answer a broad range of questions that could significantly help improve patient care and reduce costs," said Dr Paul Kuo, who heads Loyola's analytics group and is chair of the department of surgery of Loyola University Chicago Stritch School of Medicine.
[link url="http://loyolamedicine.org/newswire/news/atrial-fibrillation-after-surgery-increases-risk-heart-attacks-and-strokes-loyola"]Loyola University Medical Centre material[/link]
[link url="http://www.jurology.com/article/S0022-5347(15)03679-4/abstract"]Journal of Urology abstract[/link]