New Onset Postoperative Atrial Fibrillation Predicts Long-Term Cardiovascular Events Following Radical Cystectomy Journal Article


Authors: Blackwell, R. H.; Ellimoottil, C; Bajic, P; Kothari, A.; Zapf, M.; Kliethermes, S.; Flanigan, R.C.; Quek, M. L.; Kuo, P. C.; Gupta, G. N.
Article Title: New Onset Postoperative Atrial Fibrillation Predicts Long-Term Cardiovascular Events Following Radical Cystectomy
Abstract: INTRODUCTION: Postoperative atrial fibrillation following radical cystectomy occurs in 2-8% of cases. Recent evidence suggest that transient postoperative atrial fibrillation leads to future cardiovascular events. The long-term cardiovascular implications of postoperative atrial fibrillation in patients undergoing radical cystectomy patients are largely unknown. PATIENTS METHODS: The Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida were used to identify patients who underwent radical cystectomy between 2007-2010. After excluding patients with a prior history of atrial fibrillation, coronary artery disease, and/or stroke, patients were matched using propensity scoring on age, race, insurance status, and preexisting comorbidities. Adjusted Kaplan-Meier time-to-event analysis and Cox proportional hazards models were used to assess the effect of postoperative atrial fibrillation on cardiovascular events (acute myocardial infarction and stroke) over the first year postoperatively. RESULTS: Radical cystectomy was performed in 4,345 patients who met inclusion criteria, of whom 210 (4.8%) developed postoperative atrial fibrillation. There was a significantly higher cumulative incidence of cardiovascular events over the first postoperative year in patients who developed postoperative atrial fibrillation (24.8% vs 10.9%, adjusted Logrank p=0.007). Cox proportional hazards regression demonstrated an increased risk of cardiovascular events in postoperative atrial fibrillation patients (HR 10, p=0.02). CONCLUSIONS: Our results demonstrate that patients undergoing radical cystectomy who develop transient postoperative atrial fibrillation are at a significantly increased risk of cardiovascular events within the first postoperative year. Physicians should be vigilant in assessing postoperative atrial fibrillation, even when transient, and establish appropriate follow-up given the increased risk of cardiovascular morbidity.
Keywords: Postoperative Complications; Urology; Stroke; myocardial infarction; Atrial Fibrillation; cystectomy
Journal Title: The Journal of urology
Volume: 194
Issue: 4
ISSN: 1527-3792; 0022-5347
Publisher: Elsevier Inc  
Date Published: 2015
Start Page: 944
End Page: 949
Language: ENG
DOI/URL:
Notes: LR: 20150408; CI: Copyright (c) 2015; JID: 0376374; OTO: NOTNLM; 2015/03/27 [accepted]; aheadofprint