Risk factors and outcomes of intraoperative atrial fibrillation in patients undergoing thoracoscopic anatomic lung surgery.

backgroundAtrial fibrillation (AF) is common after thoracoscopic anatomic lung surgery and can be associated with increased adverse outcomes. However, the incidence, risk factors, and related outcomes of intraoperative AF in thoracoscopic anatomical lung surgery are unknown.

methodsWe retrospectively analyzed the files of 14,986 patients who had presented to the Shanghai Chest Hospital for thoracoscopic anatomic lung operations between January 2016 and December 2018. Univariate and multivariate analyses were conducted to identify risk factors for intraoperative AF, and a 1:1 propensity score-matched (PSM) analysis was performed to compare postoperative outcomes.

resultsThe incidence of intraoperative AF was 1.2% (177/14,986). Multivariate analysis identified age older than or equal to 60 years [odds ratio (OR) =1.872, P<0.001], male sex (OR =2.979, P<0.001), diabetes mellitus (OR =2.287, P=0.014), lesion diameter of 1.4 cm or larger (OR =1.855, P=0.002), clinical nodal involvement (OR =1.920, P=0.005), lobectomy resection (OR =2.958, P=0.001), and right resection (OR =1.475, P=0.021) as independent risk factors for intraoperative AF. After 1:1 PSM, we evaluated outcomes in 350 (175 pairs) patients with or without intraoperative AF. Patients who had intraoperative AF were associated with prolonged median ICU stay {28 [26-54]

conclusionsWe identified 7 independent risk factors for intraoperative AF, which were associated with prolonged ICU and hospital stays. The findings may help clinicians identify high-risk patients and take preventive measures to minimize the incidence and adverse outcomes of intraoperative AF.