PREDICTORS OF ATRIAL-FIBRILLATION AFTER CORONARY-ARTERY SURGERY - CURRENT TRENDS AND IMPACT ON HOSPITAL RESOURCES

Background Atrial fibrillation (AF) after coronary artery bypass surge ry (CABG) is the most common sustained arrhythmia. Its pathophysiology is unclear, and its prevention and management remain suboptimal. The aim of this prospective study was to determine the current incidence o f AF, identify its clinical predictors, and examine its impact on reso urce utilization. Methods and Results Over a 12-month period ending Ju ly 31, 1994, a CABG procedure was performed on 570 consecutive patient s (age range, 32 to 87 years; median age, 67 years; 232 [41%] were gre ater than or equal to 70 years; 175 [31%] were women; 173 [30%] were d iabetics; 364 [65%] required nonelective surgery; 86 [15%] had had a p rior CABG; and 86 [15%] had had prior percutaneous transluminal corona ry angioplasty). AF occurred in 189 patients (33%). the median age for patients with AF was 71 years compared with 66 for patients without ( P=.0001). Multivariate logistic regression analysis (odds ratio, +/-95 % CI, P value) was used to identify the following independent predicto rs of postoperative AF: increasing age (age 70 to 80 years [OR=2; CI, 1.3 to 3; P=.002], age >80 years [OR=3; CI, 1.6 to 5.8; P=.0007]), mal e gender (OR=1.7; CI, 1.1 to 2.7; P=.01), hypertension (OR=1.6; CI, 1. 0 to 2.3; P=.03), need for an intraoperative intra-aortic balloon pump (OR=3.5; CI, 1.2 to 10.9; P=.03), postoperative pneumonia (OR=3.9; CI , 1.3 to 11.5; P=.01), ventilation for >24 hours (OR=2; CI, 1.1 to 8.8 ; P=.03). The mean length of hospital stay after surgery was 15.3+/-28 .6 days for patients with AF compared with 9.3+/-19.6 days for patient s without AF (P=.001). The adjusted length of hospital stay attributab le to AF was 4.9 days, corresponding to greater than or equal to$10 05 5 in hospital charges.Conclusions AF remains the most common complicat ion after CABG and consequently is a drain on hospital resources. Conc erted efforts to reduce the incidence of AF and the associated increas ed length of stay would result in substantial cost savings and decreas e patient morbidity.