Does the surgical approach affect the incidence of postoperative atrial fibrillation after thoracic surgery? A systematic review and meta-analysis.

Postoperative atrial fibrillation (PAF) is a common complication after lung resection, since surgical stress may act as a trigger. The VATS approach reduces surgical stress and alleviates inflammation and oxidative stress commonly associated with open lung surgery. However, only a few studies have investigated the possible impact of the surgical approach on the incidence of PAF. A literature review was performed through PubMed, EMBASE, and Google Scholar in March 2024, to identify any study published since 2000 evaluating the role of the VATS vs the open approach to perform lung resections as a risk factor for postoperative atrial fibrillation. Pooled odds ratio (OR) estimates with 95% confidence intervals (CIs) were calculated. Twenty-one studies, including 59,101 patients, met the criteria for inclusion. Both propensity-matched and non-matched data showed that VATS was associated with a significant reduction in PAF compared to open thoracotomy (OT) (OR 0.73; 95% CI 0.58-0.91; I2 = 10.1%, p = 0.349). A meta-regression was conducted to explore contributing factors, showing the geographic regions in which the studies were conducted may be a significant source of heterogeneity. Subgroup analyses revealed less heterogeneity in studies conducted in Europe and on those focused solely on lobectomy. Postoperative atrial fibrillation risk following VATS is significantly lower than OT. Further prospective randomized controlled trials with large sample sizes are needed to confirm these findings.