Incidence and Impact of Atrial Fibrillation after Open Thoracotomy and VATS Pulmonary Lobectomy: A Single-Center Experience.

OBJECTIVE

The purpose of this study was to measure the incidence and impact of atrial fibrillation (AF) after open thoracotomy versus video-assisted thoracoscopic surgery (VATS) lobectomy at an academic medical center.

METHODS

With institutional review board approval, 899 patients who underwent a pulmonary lobectomy from January 2005 to December 2021 were included in this study. Postoperative AF (POAF) was defined by electrocardiography. Patients with a preoperative diagnosis of AF were excluded. Univariate analyses were conducted to identify risk factors and outcomes of POAF. Multivariate analyses were conducted to identify independent predictors and associated complications of POAF.

RESULTS

The overall incidence of AF was 9.2%. This incidence after open thoracotomy (13.0%) and VATS procedures (6.5%) was significantly different (P=0.001). An independent risk factor for POAF was age (odds ratio [OR] 1.05, P<0.001). POAF significantly increased the average number of other complications (P<0.001). Multivariate analysis revealed that postoperative acute respiratory distress syndrome (OR 3.94, P≤0.001) and atelectasis (OR 3.89, P=0.004) were independently associated with POAF. POAF did not affect in-hospital mortality (P=0.341). Patients with POAF had a significantly longer average hospital length of stay compared with those without (8.80 vs 5.84, P<0.001). The same is true for the first (3.52 vs 2.54, P=0.014) and the total length of stay in the intensive care unit (4.68 vs 3.10, P=0.009). POAF significantly increased the rate of postoperative mechanical ventilation (P=0.004), reintubation (P<0.001), and return to the operating room (P=0.003).

CONCLUSIONS

The incidence of POAF in patients who underwent an open lobectomy was significantly higher than those who underwent a VATS lobectomy. An independent risk factor for developing POAF was age. In the end, POAF greatly increased a patient's rate of postoperative complications, length of hospital and intensive care unit stay, and postoperative procedures.