Abstract 9901: In-Hospital and 30-day Post-Discharge Outcomes Associated With Postoperative Atrial Fibrillation: A Contemporary Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database

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Introduction: Postoperative atrial fibrillation (POAF) is associated with worse in-hospital and post-discharge morbidity and mortality. However, current estimates vary widely among published studies due to limited study centers and differing patient populations. The objective of this study was to assess the risk-adjusted in-hospital and 30-day post-discharge clinical outcomes associated with POAF in the United States. Methods: A contemporary, retrospective study was conducted using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database. The sample consisted of patients aged 40 to 90 who underwent open-chest coronary artery bypass and/or valvular surgery between 2011 to 2019. In-hospital and 30-day post-discharge clinical outcomes were compared between those who experienced POAF and those who did not (controls). Outcomes were risk-adjusted, where appropriate, for baseline demographics and prior medical and surgical history using a multivariable regression approach. Results: A total of 424,590 patients with a mean age of 69.3 (SD 9.2) years and 1,105,200 patients with a mean age of 64.8 (SD 10.2) years were identified in the POAF and control cohorts respectively, representing a POAF cumulative incidence of 27.8%. POAF patients experienced on average a postoperative length of stay that was 2.4 days longer (p < 0.001) and 32 additional hours (p < 0.001) in the intensive care unit compared to control patients. After risk adjustment, POAF was associated with 64% higher odds of in-hospital stroke (OR 1.64, 95% CI 1.59, 1.69), 158% higher odds of in-hospital renal failure (OR 2.58, 95% CI 2.52, 2.64), 29% higher odds of in-hospital mortality (OR 1.29, 95% CI 1.26, 1.32), 23% higher odds of 30-day readmission (OR 1.23 95% CI 1.21, 1.25), and 27% higher odds of 30-day mortality (OR 1.27, 95% CI 1.24, 1.30). Conclusions: POAF is associated with a significantly increased risk of both in-hospital and 30-days post-discharge morbidity and mortality. This study highlights the unmet need for more effective POAF prevention strategies.

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