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Impact of atrial fibrillation on long‐term survival following oesophagectomy: a 21‐year observational study
Author(s) -
Wells Cameron I.,
Robertson Jason P.,
Campbell Sandra,
AlHerz Fadhel,
Rhind Bruce,
Young Mike
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14054
Subject(s) - medicine , hazard ratio , atrial fibrillation , perioperative , esophagectomy , confidence interval , proportional hazards model , complication , retrospective cohort study , logistic regression , cohort , surgery , cohort study , esophageal cancer , cancer
Background Post‐operative atrial fibrillation ( AF ) is a common complication of oesophagectomy and thought to signal a complicated post‐operative course. AF is associated with prolonged admissions, increased healthcare costs and inpatient mortality. However, the impact of post‐operative AF on long‐term outcomes remains uncertain. Methods Patients undergoing open Ivor‐Lewis oesophagectomy from 1994 to 2014 at Palmerston North Hospital, New Zealand, were retrospectively evaluated. Demographic, perioperative and tumour variables were collected. Regression models were used to identify independent predictors of AF and assess post‐discharge survival following oesophagectomy. Results In total, 89 patients were included. New‐onset AF developed post‐operatively in 27 patients (30%). Median follow‐up was 6.3 years. Logistic regression identified volume of intravenous fluid in the first 24 h post‐operatively as a predictor of AF . Post‐discharge survival was predicted by AF occurrence (hazard ratio ( HR ): 2.99, 95% confidence interval ( CI ): 1.37–6.53, P = 0.006), preoperative chemoradiotherapy ( HR : 0.43, 95% CI : 0.20–0.91, P = 0.03), 1–4 positive lymph nodes ( HR : 2.29, 95% CI : 1.06–4.96, P = 0.04), ≥5 positive nodes ( HR : 2.95, 95% CI : 1.25–6.94, P = 0.01) and year of operation from 2008 to 2014 ( HR : 0.30, 95% CI : 0.12–0.75, P = 0.01). Conclusion Post‐operative AF was associated with poorer long‐term survival following oesophagectomy in this cohort. Further research should evaluate the influence of AF on cardiovascular and oncological outcomes following oesophagectomy.