Characterization of Institution-Specific Risk Factors for Post-Operative Atrial Fibrillation in Patients Undergoing Cardiac Surgery
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Publication Date
2025
Keywords
oregon, oaa 2025, psvmc
Disciplines
Cardiology | Medical Education | Pharmacy and Pharmaceutical Sciences
Abstract
Abstract: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Risk assessment tools have attempted to predict POAF using factors such as comorbidities, cardiac function, and perioperative characteristics, but these variables have not been consistently validated or standardized across diverse patient populations. This retrospective, single-center study aimed to characterize the proposed clinical and perioperative POAF risk factors in patients undergoing coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral valve replacement (MVR), or a combination of these procedures at Providence St. Vincent Medical Center between July 30, 2022, and September 2, 2024. Following IRB approval in December 2024, 1,287 patients were screened using the Adult Cardiac Surgery Database; of these, 951 met inclusion criteria and were stratified into two groups: those who developed POAF after 48 hours post-procedure and those who did not. Comparative analyses were conducted using Wilcoxon rank-sum, chi-square, and T-tests. Patient characteristics studied include age, gender, comorbidities (e.g., hypertension, COPD, diabetes), procedure characteristics, and relevant periprocedural medications. Perioperative electrolyte levels (potassium and magnesium) were also collected via Epic’s SlicerDicer tool and manual chart review. Analysis of potassium and magnesium trends are ongoing to evaluate their potential predictive value. Results indicated that POAF was more common among patients undergoing complex procedures, particularly combination surgeries including AVR + CABG (9.21% POAF vs. 7.42% non-POAF, p < 0.000001), MVR + CABG (2.3% POAF vs. 0.31% non-POAF, p < 0.000001), as well as isolated MVR (3.95% POAF vs. 2.47% non-POAF). In contrast, isolated CABG (39.1% POAF vs. 51.3% non-POAF, p < 0.000001) and AVR (12.17% POAF vs. 15.3% non-POAF, p 0.000001) were associated with lower POAF incidence, suggest-ing that procedure type and additive effects of combination surgery significantly impacts arrhythmia risk. While many baseline characteristics were similar be-tween groups, POAF was more frequent in patients with COPD (22% POAF vs 17% non-POAF, p < 0.05), prior cerebrovascular accidents (10.86% POAF vs. 6.34% non-POAF, p < 0.02), and history of myocardial infarction occurring 21 days or later prior to surgery (13.82% POAF vs 10.97% non-POAF, p < 0.05). Additionally, postoperative serum creatinine 48 hours post-surgery was statistically significantly higher in the POAF group (p < 0.004), indicating an association with renal dysfunction. These findings are consistent with prior research linking procedural complexity and cardiopulmonary comorbidities to POAF, though the stronger associations seen with combination valve procedures and renal dysfunction are less well described in the literature.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Surgery
