New-onset Afib tied to complications and mortality risk after oesophagectomy

  • Schizas D & al.
  • Br J Surg
  • 1 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Coronary artery disease (CAD) and hypertension are the risk factors for the development of new-onset atrial fibrillation (Afib), which is commonly observed in patients undergoing oesophagectomy after cancer.
  • Post-operative Afib is associated with an increased risk for complications and mortality.

Why this matters

  • Rates of new-onset Afib as high as 40% have been reported after oesophagectomy.

Study design

  • 53 studies (4 randomised controlled trials, 49 observational studies; n=9087) met eligibility criteria after a search across electronic databases.
  • Primary outcomes: incidence new-onset Afib after oesophagectomy and difference in post-operative mortality between patients with and without Afib.
  • Secondary outcomes: incidence of pneumonia and anastomotic leak.
  • Funding: None disclosed.

Key results

  • The overall incidence of post-operative Afib was 16.5% (95% CI, 15.4-17.2%).
  • CAD (OR, 1.47; 95% CI, 1.07-2.02) and hypertension (OR, 2.63; 95% CI, 1.38-5.02) were associated with Afib development within 30 days after surgery.
  • Patients with Afib vs those without had a significantly higher risk for:
    • overall post-operative adverse events (OR, 5.40; 95% CI, 3.51-8.30);
    • mortality (OR, 2.49; 95% CI, 1.70-3.64);
    • anastomotic leak (OR, 2.65; 95% CI, 1.53-4.59); and
    • pneumonia (OR, 3.42; 95% CI, 2.39-4.90).

Limitations

  • Risk of bias.
  • Study may have under-reported Afib.

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