ArticleInternational journal of surgery (London, England)2026
Adherence to guideline recommendations for postoperative atrial fibrillation: a nationwide survey reveals major prevention gaps.
Article in International journal of surgery (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG). Adherence to guideline recommendations for POAF is crucial but remains poorly understood. We aimed to investigate knowledge, guideline adherence, and implementation barriers related to POAF management in China-one of the largest CABG populations worldwide. MATERIALS AND
methodsWe conducted a national, multicenter, cross-sectional survey using multistage sampling across 32 tertiary hospitals in 25 provinces. A total of 1047 participants, including cardiac surgeons qualified to perform CABG and nurses, were enrolled. Guideline adherence and knowledge were assessed, and barriers were analyzed using the Theoretical Domains Framework.
resultsGuideline adherence was suboptimal, with mean scores of 63.0 ± 13.6 for surgeons and 61.7 ± 15.7 for nurses. Preventive strategies were particularly underutilized: over 80% of practitioners reporting no prophylactic interventions for high-risk patients. While adherence to monitoring protocols was high (>95%), risk assessment practices were inadequate, with only 19.6% of surgeons conducting preoperative POAF risk assessments. Guideline-recommended prophylactic medications were underutilized (β-blockers: 44.2%, amiodarone: 18.1%). CHA2DS2-VASc and HAS-BLED scores were rarely used (70%-80% never). Knowledge assessment revealed major deficiencies: only 44.7% of surgeons and 9.3% of nurses achieved passing scores (≥60/100). Key barriers included organizational non-requirement, doubts about prophylactic efficacy, safety concerns among surgeons, and fear of misjudgment and perceived role limitations in nurses. Knowledge score, receiving POAF training, and geographic region were significant predictors of knowledge and guideline adherence.
conclusionThis first national survey in China reveals substantial gaps in POAF knowledge and guideline adherence, particularly concerning preventive care. Our findings highlight the global challenge of translating evidence-based POAF recommendations into practice. They emphasize the need for targeted implementation strategies that account for healthcare system constraints in developing economies with large cardiovascular disease burdens.
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