P3766New-onset peri-operative atrial fibrillation is associated with increased mortality in patients undergoing total knee and hip replacements

Abstract

Abstract Background Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgeries performed in elderly patients with osteoarthritis. Limited data address the clinical significance of peri-operative atrial fibrillation (AF) in these patients. Purpose This study aimed to determine whether pre-existing or new onset AF is associated with increased 1-year mortality rates. Methods 280 patients over the age of 60 undergoing THA or TKA with peri-operative AF and 280 control matched patients were retrospectively identified, and their files reviewed. The primary endpoint was 1-year mortality from the date of the surgery. Results Of the 280 patients with peri-operative AF, 37 had new onset AF with a 1-year mortality rate of 10.8%. This mortality was significantly higher in patients with new-onset AF compared to patients without AF or patients with previous AF (10.8%, vs. 1.1% and 2.5%, respectively; p=0.005). On multivariate analysis, this difference remained significant after adjustment for risk factors associated with mortality. Variables associated with mortality Characteristic P value Adjusted Odds Ratio 95% confidence interval When AF type is included: Chronic renal failure 0.004 7.64 1.91–30.64 Timing of AF (New onset) 0.005 9.95 1.99–49.77 When AF timing is included: Chronic renal failure 0.005 7.47 1.83–30.40 Timing of AF (post-op) 0.0.1 7.59 1.62–35.62 AF, atrial fibrillation. Conclusion One-year mortality in elderly patients undergoing TKA or THA is significantly increased in patients with new postoperative AF. These patients warrant increased clinical surveillance following surgery.