Anesthesia Experts

Perioperative Atrial Fibrillation Increases Long-Term Risk for Stroke

by Leave a Comment

Authors: Gialdini G et al., JAMA 2014 Aug 13; 312:616

Usually considered secondary to the stress of surgery, perioperative AF was associated with elevated risk for ischemic stroke 1 year later.

Perioperative atrial fibrillation (AF) is common in cardiac surgery and is also seen in noncardiac surgery. Because AF is thought to be secondary to local inflammation (pericardial) in cardiac surgery and generalized stress in cardiac and noncardiac surgery, it is not considered to increase the risk for stroke once the stress of surgery has resolved.

Using a large, California State database of 1,729,360 patients hospitalized for surgery, investigators compared the long-term outcomes of patients with and without perioperative AF. Patients with preoperative AF were excluded from the analysis.

New-onset AF occurred in 24,711 patients (1.43%) during the perioperative period and was more common in cardiac surgery (16.10%) compared with noncardiac surgery (0.78%). During a mean follow-up of 2.1 years, 13,952 patients experienced an ischemic stroke. At 1 year of follow-up in the cardiac surgery group, the incidence of stroke was 0.99% in those with perioperative AF and 0.83% in those without perioperative AF (hazard ratio, 1.3; 95% confidence interval, 1.1–1.6). The association was stronger in the noncardiac surgery group (incidence of stroke, 1.47% vs. 0.36% in patients with vs. without perioperative AF; HR, 2.0; 95% CI, 1.7–2.3).

Comment — Cardiology

Perioperative AF increases the risk for stroke twofold at 1 year after noncardiac surgery. Presumably, this increased risk for stroke is secondary to AF during follow-up. The occurrence of perioperative AF, especially in patients undergoing noncardiac surgery, should be taken seriously. Although the results of this study do not justify long-term anticoagulation in all patients with perioperative AF, they do support close follow-up for the development of non-perioperative AF in order to continue or begin anticoagulation.

 

Leave a Reply

Call (660) 596-2224
What people thought about us

Testimonials

“As Director of Surgical Services Departments there has been considerable changes have occurred in my department and Anesthesia Experts has always risen to meet our demands of our facility. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services.”

AR BSN 346 beds AL   

“Before AE took over the anesthesia department was described by the surgeons as the worst in the history of our hospital. The prior management company was having a cancelled surgery per day. I am happy to report there has not been one since they have taken over the department. Additionally we have seen a 905 reduction if requested preop
lab tests. The anesthesia department is now the very best hospital department in our entire facility.”

DS CEO 272 beds MS   

“Anesthesia Experts has provided consistent anesthesia providers who display a high degree of integrity, responsibility and professionalism. They have become a more valuable part of our facility and community.”

LR CEO 150 beds TX   

“Even though they are physically located 1000 miles away Anesthesia Experts just does not provide great anesthesia coverage they personally engage surgeons to increase their business. Last year my surgical volume rose by 24% and we are currently 50% ahead of last year and all of that growth is organic.”

JE FACHE CEO AL 92 bed hospital   

“Anesthesia Experts is more responsive than anyone I have dealt with. They are available by phone whenever needed and will be on site for any need or request and has been on site to address issues before we can make the request.”

SW CEO 25 beds NM   

“While problems are extremely rare when they do occur Anesthesia Experts quickly and professionally implements a solution. Our surgical volume has grown over 100 cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!”

SP CEO 346 beds AL   

“Our anesthesia department was a thorn in my side that kept me awake at night. Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.”

JAM CNO AL 89 bed hospital   

Add a Testimonial

Verification Captcha