Year 2022 Vol. 30 No 3

SCIENTIFIC PUBLICATIONS

E.E. ABDUROZIKOV 1, O.N. DZHIOEVA 2, 3, V.A. SHVARTZ 4, A.R. KISELEV 2, E.A. ROGOZHKINA 1, O.M. DRAPKINA 2

PREDICTORS OF MORTALITY AND POSTOPERATIVE ATRIAL FIBRILLATION AFTER NON-CARDIAC SURGERY

State Budgetary Health Institution, City Clinical Hospital
named after V.V. Veresaev of the Department of Health of Moscow 1,
"National Medical Research Center for Therapy and Preventive Medicine"
of the Ministry of Health of Russian Federation 2,
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
of the Ministry of Health of Russian Federation 3,
National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev
of the Ministry of Health of Russian Federation 4, Moscow,
Russian Federation

Objective. This paper specifically focuses on the study of determination of the predictors associated with the development of postoperative atrial fibrillation (POAF) and mortality rate after major abdominal non-cardiac surgical interventions.
Methods. The methodology Case-control study has been used. The study included 226 patients: 83 - with a fatal outcome (cases) and 143 without a fatal outcome (control group).
Results. Independent predictors increasing risk of POAF developing were considered to be the followings: myocardial infarction in the anamnesis (MI) (OR 4.7, CI 2.2-10.1), cardiac arrhythmias (OR 5.0, CI 2.5-10.3), chronic kidney disease (CKD) (OR 8.7, CI 4.6-16.5), congestive heart failure (CHF) (OR 9.9, CI 5.2-19.1), diabetes (OR 4.0, CI 2-8), chronic obstructive pulmonary disease (COPD) (OR 8.6, CI 1.7-42.3), intraoperative infusion of more than 3 liters (OR 3.4, CI 1.6-7,4). Independent predictors increasing the risk of mortality rate were the followings: cardiac arrhythmias in the anamnesis (OR 3,4, CI 1.7-6,9), CKD (OR 248, CI 80-764), CHF 2-3 class (OR 6,8, CI 3,7-12,6), diabetes (OR 4.9, CI 2.3-9,6), COPD (OR CI 6,5, 1,3-32), intraoperative infusion of more than 3 liters (OR 2.9, CI 1.46-5.7), post-surgery fluid therapy of 3-5 liters (OR 2,9 1,6-5,0), POAF (OR 14,8, CI 7,4-29,4), thromboembolic complications (OR 37,9, CI 8,7-164). Age (>72 years) was statistically significant (p<0.001) was associated with POAF and with mortality rate.
Conclusion. In abdominal non-cardiac surgical interventions. the development of POAF is a common complication of cardiac surgery. In patients with POAF, the risk of in-hospital mortality is significantly higher. Independent factors that increase the risk of mortality rate and POAF are largely similar and in this study were the followings: myocardial infarction in the anamnesis, heart rate variabily, chronic heart failure, chronic renal failure, diabetes, chronic obstructive pulmonary disease, as well as relaporotomy, inflammation and pneumonia. The quantitative component of the extra volume of infusion therapy associated with perioperative complications was also recorded.

Keywords: postoperative atrial fibrillation, new onset atrial fibrillation, non-cardiac surgery, cardiovascular complications, mortality, surgery, inflammation
p. 245-254 of the original issue
References
  1. Devereaux PJ, Chan M, Eikelboom J. Major vascular complications in patients undergoing noncardiac surgery: The magnitude of the problem, risk prediction, surveillance, and prevention. In: DPhil SY, Cairns JA, Camm AJ, Fallen EL, Gershl BJ, editors. Evidence?Based Cardiology. 3-rd ed. Blackwell Publishing Ltd; 2010. . 47-62. doi: 10.1002/9781444309768
  2. Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J. 2012 Dec;164(6):918-24. doi: 10.1016/j.ahj.2012.09.004
  3. Danelich IM, Lose JM, Wright SS, Asirvatham SJ, Ballinger BA, Larson DW, Lovely JK. Practical management of postoperative atrial fibrillation after noncardiac surgery. J Am Coll Surg. 2014 Oct;219(4):831-41. doi: 10.1016/j.jamcollsurg.2014.02.038
  4. Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS, Kamel H. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA. 2014 Aug 13;312(6):616-22. doi: 10.1001/jama.2014.9143
  5. Park SJ, Choi JH, Cho SJ, Chang SA, Choi JO, Lee SC, Park SW, Oh JK, Kim DK, Jeon ES. Comparison of transthoracic echocardiography with N-terminal pro-brain natriuretic Peptide as a tool for risk stratification of patients undergoing major noncardiac surgery. Korean Circ J. 2011 Sep;41(9):505-11. doi: 10.4070/kcj.2011.41.9.505
  6. Liu MH, Chiou AF, Wang CH, Yu WP, Lin MH. Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study. Health Qual Life Outcomes. 2021 Nov 6;19(1):252. doi: 10.1186/s12955-021-01885-8
  7. Lowres N, Mulcahy G, Jin K, Gallagher R, Neubeck L, Freedman B. Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2018 Mar 1;26(3):504-11. doi: 10.1093/icvts/ivx348
  8. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C; Authors/Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014 Sep 14;35(35):2383-431. doi: 10.1093/eurheartj/ehu282
  9. Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019 Jul;16(7):417-36. doi: 10.1038/s41569-019-0166-5
  10. Walkey AJ, Benjamin EJ, Lubitz SA. New-onset atrial fibrillation during hospitalization. J Am Coll Cardiol. 2014 Dec 9;64(22):2432-33. doi: 10.1016/j.jacc.2014.09.034
  11. Christians KK, Wu B, Quebbeman EJ, Brasel KJ. Postoperative atrial fibrillation in noncardiothoracic surgical patients. Am J Surg. 2001 Dec;182(6):713-15. doi: 10.1016/s0002-9610(01)00799-1
  12. Sohn GH, Shin DH, Byun KM, Han HJ, Cho SJ, Song YB, Kim JH, On YK, Kim JS. The incidence and predictors of postoperative atrial fibrillation after noncardiothoracic surgery. Korean Circ J. 2009 Mar;39(3):100-4. doi: 10.4070/kcj.2009.39.3.100
  13. Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med. 1998 Aug 15;129(4):279-85. doi: 10.7326/0003-4819-129-4-199808150-00003
  14. Butt JH, Olesen JB, Havers-Borgersen E, Gundlund A, Andersson C, Gislason GH, Torp-Pedersen C, Køber L, Fosbøl EL. Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery. J Am Coll Cardiol. 2018 Oct 23;72(17):2027-36. doi: 10.1016/j.jacc.2018.07.088
  15. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005 Jul;103(1):25-32. doi: 10.1097/00000542-200507000-00008
  16. Cecconi M, Hofer C, Teboul JL, Pettila V, Wilkman E, Molnar Z, Della Rocca G, Aldecoa C, Artigas A, Jog S, Sander M, Spies C, Lefrant JY, De Backer D; FENICE Investigators; ESICM Trial Group. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Med. 2015 Sep;41(9):1529-37. doi: 10.1007/s00134-015-3850-x
  17. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F. Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003 Nov;238(5):641-48. doi: 10.1097/01.sla.0000094387.50865.23
  18. Curry FR. Atrial natriuretic peptide: an essential physiological regulator of transvascular fluid, protein transport, and plasma volume. J Clin Invest. 2005 Jun;115(6):1458-61. doi: 10.1172/JCI25417
Address for correspondence:
Russian Federation, Moscow,
Rublevskoe highway 135,
Federal State Budgetary Institution National Medical
Research Center for Cardiovascular Surgery named
after N.N. A.N. Bakulev of the Ministry of Health
of Russian Federation.. Department of Surgical
Treatment of Interactive Pathology,
Tel. +79032619292
e-mail: shvartz.va@ya.ru
Shvartz Vladimir A.
Information about the authors:
Abdurozikov Eldor E., Physician of Functional Diagnostics, State Budgetary Health Institution, City Clinical Hospita named after V.V. Veresaev of the Department of Health of Moscow, Moscow, Russian Federation
https://orcid.org/0000-0002-5276-4032
Dzhioeva Olga N., MD, Senior Researcher, Department of Fundamental and Applied Aspects of Obesity, Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia; Associate Professor, Department of Therapy and Preventive Medicine, Federal State Budgetary Institution of Higher Education, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov of the Ministry of Health of Russian Federation, Moscow, Russian Federation
https://orcid.org/0000-0002-5384-3795
Shvartz Vladimir A., MD, Researcher at the Department of Surgical Treatment of Interactive Pathology, Associate Professor of the Department of Cardiovascular Surgery with a Course in Arrhythmology and Clinical Electrophysiology, Federal State Budgetary Institution National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev of the Ministry of Health of Russian Federation,. Moscow, Russian Federation
https://orcid.org/0000-0002-8931-0376
Kiselev Anton R., MD, Head of the Center for the Coordination of Fundamental Scientific Activities, Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia, Moscow, Russian Federation
https://orcid.org/0000-0003-3967-3950
Rogozhkina Elizaveta A., Trainee Physician, City Clinical Hospital Named after V.V. Veresaev of the Department of Health of Moscow, Moscow, Russian Federation.
https://orcid.org/0000-0001-8993-7892
Drapkina Oksana M., Corresponding Member RAS, MD, Professor, Director Federal State Budgetary Institution National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russian Federation, Head of the Department of Therapy and Preventive Medicine of Federal State Budgetary Institution of Higher Education, Moscow State University of Medicine and Dentistry Named after A.I. Evdokimov of the Ministry of Health of Russian Federaration, Moscow, Russian Federation.
https://orcid.org/0000-0002-4453-8430
Contacts | ©Vitebsk State Medical University, 2007-2023