Original article
General thoracic
Risk Factors for Atrial Fibrillation After Lung Cancer Surgery: Analysis of The Society of Thoracic Surgeons General Thoracic Surgery Database

Presented at the Forty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 25–27, 2010.
https://doi.org/10.1016/j.athoracsur.2010.03.100Get rights and content

Background

Atrial fibrillation is responsible for significant morbidity after lung cancer surgery, and preoperative and perioperative risk factors are not well described.

Methods

The Society of Thoracic Surgeons (STS) database was queried for all lobectomy and pneumonectomy patients with a diagnosis of lung cancer. A multivariable logistic regression model was developed to predict the risk of atrial arrhythmia as a function of preoperative and perioperative factors. Generalized estimating equations methodology was used to account for correlation among observations from the same institution. Missing data were handled using the method of chained equations with 10 randomly imputed data sets.

Results

A total of 13,906 patients who underwent resection for lung cancer at participating institutions had complete information for postoperative atrial arrhythmia, of whom 1,755 (12.6%) experienced the outcome. Multivariable logistic analysis indentified increasing age, increasing extent of operation, male sex, nonblack race, and stage II or greater tumors as predictors of postoperative atrial fibrillation.

Conclusions

Analysis of the STS database has identified five variables that predict postoperative atrial fibrillation. This predictive model may be useful to develop strategies for risk stratification, prophylaxis, and treatment.

Section snippets

The STS National General Thoracic Surgery Database

The STS National General Thoracic Surgery Database (GTSD) is a voluntary database that was initiated in 1999, and reports began to be issued in 2002. At the time of the last report (November 2009), there were 111 participants. Harvests and reports are made semianually to provide participants with their risk-adjusted outcomes compared with the national experience. Harvested data are maintained and analyzed by the Duke Clinical Research Institute in compliance with the Health Insurance

Baseline Features and Outcomes

A total of 14,041 patients met criteria for the study. Of these, 13,906 had complete information regarding the outcome of atrial arrhythmia after surgery. Of those patients, 1,755 (12.6%) developed an atrial arrhythmia before discharge from the hospital. Table 1 demonstrates the demographic characteristics of the entire cohort. As expected, the patients were elderly smokers with the usual range of comorbidities. Pulmonary function was generally good, and the vast majority of patients were early

Comment

We sought to use the STS GTSD to identify risk factors for atrial arrhythmia after lobectomy or greater for primary lung cancer. Our multivariable model identified increasing age, increasing extent of operation, male sex, nonblack race, and clinical stage II or greater tumors as predictive of postoperative atrial arrhythmia. A reduced model containing these five variables allows stratification of patients into high-risk categories for possible future trial of pharmacologic prophylaxis.

Strengths

References (22)

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