SUPRAVENTRICULAR ARRHYTHMIA IN PATIENTS HAVING NONCARDIAC SURGERY - CLINICAL CORRELATES AND EFFECT ON LENGTH OF STAY

Background: Few recent data are available on risk factors for perioper ative supraventricular arrhythmia (SVA) after noncardiac surgery or on the effect of SVA on clinical outcomes. Objective: To determine the i ncidence, clinical correlates, and effect on length of stay of periope rative SVA in patients having major noncardiac surgery. Design: Prospe ctive cohort study. Setting: Urban tertiary care teaching hospital. Pa rticipants: 4181 patients 50 years of age or older who had major, none mergency, noncardiac procedures and were in sinus rhythm at the preope rative evaluation. Measurements: Preoperative clinical data, postopera tive enzyme data, serial electrocardiograms, and clinical outcomes wer e collected prospectively. Outcomes were 1) SVA that persisted or led to treatment and 2) increase in length of stay attributable to SVA. Re sults: Perioperative SVA occurred in 317 patients (7.6%); it occurred in 83 patients (2.0%) during surgery and in 256 (6.1 %) after surgery. Independent preoperative correlates of SVA were male sex (odds ratio [OR], 1.3 [95% CI, 1.0 to 1.7]), age 70 years or older (OR, 1.3 [CI, 1 .0 to 1.7]), significant valvular disease (OR, 2.1 [CI, 1.2 to 3.6]), history of SVA (OR, 3.4 [CI, 2.4 to 4.8]) or asthma (OR, 2.0 [CI, 1.3 to 3.1]), congestive heart failure (OR, 1.7 [CI, 1.1 to 2.7]), prematu re atrial complexes on preoperative electrocardiography (OR, 2.1 [CI, 1.3 to 3.4]), American Society of Anesthesiologists class III or IV (O R, 1.4 [CI, 1.1 to 1.9]), and type of procedure: abdominal aortic aneu rysm (OR, 3.9 [CI, 2.4 to 6.3]) or abdominal (OR, 2.5 [CI, 1.7 to 3.6] ), vascular (OR, 1.6 [CI, 1.1 to 2.4]), and intrathoracic (OR, 9.2 [CI , 6.7 to 13]) procedures. Among patients who had intrathoracic surgery , those receiving digoxin were at lower risk (OR, 0.2 [CI, 0.04 to 0.8 ]) for SVA than those not receiving digoxin. Patients with perioperati ve acute cardiac and noncardiac events had high relative risks for SVA . Supraventricular arrhythmia was associated with a 33% increase in le ngth of stay after adjustment for other clinical data (P < 0.001). Con clusions: In this cohort, SVA was common after noncardiac surgery and was associated with prolonged length of stay.