Abstract
BackgroundAtrial fibrillation (AF) after thoracic surgery is a continuing source of morbidity and mortality. The effect of postoperative AF on long-term survival however has not been studied. Our aim was to evaluate the impact of AF on early outcome and on survival > 5 years after pulmonary lobectomy for lung cancer.MethodsFrom 1996 to June 2009, 454 consecutive patients undergoing lobectomy for lung cancer were enrolled and followed-up until death or study end (October 2010). Patients with postoperative AF were identified; AF was investigated with reference to its predictors and to short- and long-term survival (> 5 years).ResultsHospital mortality accounted for 7 patients (1.5%), while postoperative AF occurred in 45 (9.9%). Independent AF predictors were: preoperative paroxysmal AF (odds ratio [OR] 5.91; 95%CI 2.07 to 16.88), postoperative blood transfusion (OR 3.61; 95%CI 1.67 to 7.82) and postoperative fibro-bronchoscopy (OR 3.39; 95%CI 1.48 to 7.79). Patients with AF experienced higher hospital mortality (6.7% vs. 1.0%, p = 0.024), longer hospitalization (15.3 ± 10.1 vs. 12.2 ± 5.2 days, p = 0.001) and higher intensive care unit admission rate (13.3% vs. 3.9%, p = 0.015). The median follow-up was 36 months (maximum: 179 months). Among the 445 discharged subjects with complete follow-up, postoperative AF was not an independent predictor of mortality; however, among the 151 5-year survivors, postoperative AF independently predicted poorer long-term survival (HR 3.75; 95%CI 1.44 to 9.08).ConclusionAF after pulmonary lobectomy for lung cancer, in addition to causing higher hospital morbidity and mortality, predicts poorer long-term outcome in 5-year survivors.
Highlights
Atrial fibrillation (AF) after thoracic surgery is a continuing source of morbidity and mortality
AF and early outcome Hospital mortality accounted for 7 (1.5%) subjects, while AF occurred in 9.9% of patients (45 of 454) and its frequency peaked on the second postoperative day (69% of cases)
Our study confirms the negative impact of AF on hospital mortality after lobectomy for lung cancer; in addition, it provides the first evidence that patients with postoperative AF who survive 5 years have a significantly reduced long-term survival
Summary
Atrial fibrillation (AF) after thoracic surgery is a continuing source of morbidity and mortality. Our aim was to evaluate the impact of AF on early outcome and on survival > 5 years after pulmonary lobectomy for lung cancer. Atrial fibrillation (AF) remains the most common medical complication after thoracic surgery, with an incidence ranging from 10% to 20% after pulmonary lobectomy, and as much as 40% after pneumonectomy [1,2,3,4,5,6,7]. The prognostic implications of this arrhythmia after pulmonary lobectomy for lung cancer remain controversial. The primary aim of this study was to assess the impact of AF on early outcome and on survival > 5 years from pulmonary lobectomy for lung cancer. Factors associated with AF development after lobectomy were investigated
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