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OBJECTIVES:It is well established that transient postoperative atrial fibrillation (TPAF) is associated with adverse postoperative outcomes after major cardiac and non-cardiac operations. The purpose of this study is to elucidate the incidence, impact and risk factors associated with the development of TPAF in patients undergoing revascularization surgery for occlusive diseases of the abdominal aorta and its branches (AAB).
METHODS: Using Healthcare Cost and Utilization Project State Inpatient Database from Florida and California, patients who underwent open revascularization of AAB between 2006 and 2011 were identified. Patients diagnosed with aortic dissection or abdominal aortic aneurysm were excluded to limit the study cohort to only include patients with occlusive etiology. Also excluded were those with a pre-existing diagnosis of atrial fibrillation, and those who underwent thoracic aortic repair and peripheral artery revascularization procedures. Multivariate logistic and linear regression analyses with treatment effects were conducted to analyze the association between TPAF and length of stay; the mortality rates at index admission, 1 month, and 1 year; and the readmission rates at 1 month and 1 year (adjusted for comorbidities, surgical and demographic factors). A backwards stepwise logistic regression model was built to identify predictors of TPAF.
RESULTS: A total of 4,462 patients were identified: 3,253 underwent aorto-iliac-femoral bypasses (72.9%), 1,514 endarterectomies of AAB (33.9%), and 288 bypasses of AAB (6.5%). The incidence of TPAF was 2.4% (109 patients). Multivariate regression analysis with treatment effects showed that TPAF was associated with significantly increased length of stay (LOS), mortality and readmission rates (Table). Factors identified as predictors of TPAF by logistic regression modeling include: electrolyte disorders, chronic lung disease, history of myocardial infarction, absence of hypertension, as well as increases in age, number of concomitant procedures and Charlson comorbidity index (c-statistic=0.72, accuracy=62.2%).
CONCLUSIONS:TPAF after revascularization of AAB is associated with increased LOS, inpatient mortality, 1 year mortality and hospital readmissions. Strategies to identify patients at risk of developing TPAF and implementation of appropriate prophylactic measures may improve surgical outcomes and reduce cost of care.

Outcomes: *Adjusted for comorbidities, surgical & demographic factors

Outcomes	aOR*	p
Mortality in-patient (during procedure admission)	1.08	0.007
Mortality in-patient + at 30 days	1.08	0.015
Mortality at 1 year	1.14	<0.001
Readmission within 1 month	1.15	<0.001
	aCoefficient*	p
Length of Stay	7.25	<0.001