ArticleCureus2026
A Prospective Clinical Audit to Improve Compliance With Perioperative Atrial Fibrillation Prevention Protocols in Off-Pump Coronary Artery Bypass Surgery.
Article in Cureus, 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
Background New-onset atrial fibrillation (AF) is a frequent complication following cardiac surgery and is associated with significant mortality and morbidity. This audit evaluated adherence to perioperative AF prevention standards and the effect of targeted quality-improvement measures in off-pump coronary artery bypass grafting (OPCAB) patients. Methodology Two prospective audit cycles were performed at the Apollo Imperial Hospitals. Cycle 1 (January to September 2024; n=95 eligible) established baseline compliance with three standards: the continuation of beta-blocker on the morning of surgery, maintenance of perioperative serum potassium at 4.5-5.0 mmol/L, and reinstitution of beta-blocker within 12 hours postoperatively. After multidisciplinary interventions (permanent ICU/OR posters, checklist attached to patient records, weekly team meetings, and four-times-daily ward rounds), improvement was assessed in cycle 2 (November 2024 to July 2025; n=101). Bisoprolol was the institutional beta-blocker; ivabradine was used if beta-blockers were contraindicated. Categorical variables were analyzed using the chi-square test or Fisher's exact test, and relative risk (RR) and odds ratios (OR) were estimated with 95% confidence intervals (CI). Results Preoperative beta-blocker continuation improved from 66.3% to 94.1% (p<0.001). Serum potassium maintenance within target increased from 42.1% to 81.2% (p<0.001). Reinstitution rates were high in both cycles (96.8% versus 95.0%, p=0.72). New-onset AF incidence decreased from 34.7% to 16.8% (p=0.0067; RR: 0.48 {95% CI: 0.29-0.81}; OR: 0.38 {95% CI: 0.19-0.74}). Conclusion Structured, multidisciplinary quality-improvement measures significantly improved compliance with AF prevention protocols and were associated with a decrease in postoperative AF incidence by 50% in OPCAB patients. Routine audits and sustained adherence to protocol are recommended.
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