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Predictors, Outcomes, and Resource Utilization

Joseph P. Mathew, MD; Reg Parks, MPH; Joseph S. Savino, MD; Arnold S. Friedman, MD; Colleen Koch, MD; Dennis T. Mangano, PhD, MD; Warren S. Browner, MD, MPH

JAMA. 1996;276(4):300-306.

Abstract
Objective.
—To determine the incidence, predictors, and cost of atrial fibrillation and flutter (AFIB) following coronary artery bypass graft (CABG) surgery.

Design.
—Prospective observational study (MultiCenter Study of Perioperative Ischemia).

Setting.
—Twenty-four university-affiliated hospitals in the United States from 1991 to 1993.

Subjects.
—A total of 2417 patients undergoing CABG with or without concurrent valvular surgery selected using a systematic sampling interval.

Measurements.
—Detailed preoperative, intraoperative, and postoperative data collected on standardized reporting forms.

Results.
—The overall incidence of postoperative AFIB was 27%. Independent predictors of postoperative AFIB included advanced age (odds ratio [OR], 1.24 per 5-year increase; 95% confidence interval [CI], 1.18-1.31); male sex (OR, 1.41; 95% CI, 1.09-1.81); a history of AFIB (OR, 2.28; 95% CI, 1.74-3.00); a history of congestive heart failure (OR, 1.31; 95% CI, 1.04-1.64); and a precardiopulmonary bypass heart rate of more than 100 beats per minute (OR, 1.59; 95% CI, 1.00-.00-2.55). Surgical practices such as pulmonary vein venting (OR, 1.44; 95% CI, 1.13-1.83); bicaval venous cannulation (OR, 1.40; 95% CI, 1.04-1.89); postoperative atrial pacing (OR, 1.27; 95% CI, 1.00-1.62); and longer cross-clamp times (OR, 1.06 per 15 minutes; 95% CI, 1.00-1.11) also were identified as independent predictors of postoperative AFIB. Patients with postoperative AFIB remained an average of 13 hours longer in the intensive care unit and 2.0 days longer in the ward when compared with patients without AFIB.

Conclusion.
—Postoperative AFIB is common after CABG surgery and has a significant effect on both intensive care unit and overall hospital length of stay. In addition to expected demographic factors, certain surgical practices increase the risk of postoperative AFIB. Randomized controlled trials are necessary to determine if modification of these surgical practices, especially in patients at high risk, would decrease the incidence of postoperative AFIB.

Author Affiliations
for the MultiCenter Study of Perioperative Ischemia Research Group

From the Department of Anesthesiology, Yale University School of Medicine, New Haven, Conn (Dr Mathew); Department of Epidemiology, Ischemia Research and Education Foundation, San Francisco, Calif (Mr Parks); Department of Anesthesiology, University of Pennsylvania Medical Center, Philadelphia (Dr Savino); Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, Calif (Dr Friedman); Department of Cardiothoracic Anesthesiology, The Cleveland (Ohio) Clinic Foundation (Dr Koch); Department of Anesthesiology, University of California, San Francisco (Dr Mangano); and Departments of Medicine, Epidemiology and Biostatistics, and Anesthesiology, Veterans Affairs Medical Center/University of California, San Francisco (Dr Browner).

Footnotes
A complete list of the members of the MultiCenter Study of Perioperative Ischemia Research Group appears at the end of this article.

Reprints: Joseph P. Mathew, MD, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St, Tompkins-3, New Haven, CT 06510.

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