Effect of postoperative atrial fibrillation on length of stay after cardiac surgery (the postoperative atrial fibrillation in cardiac surgery study [PACS2])

作者: Michael H Kim , G.Michael Deeb , Fred Morady , David Bruckman , Lucille R Hallock

DOI: 10.1016/S0002-9149(00)01530-7

关键词: Heart diseaseNormal Sinus RhythmClinical pathwayAnesthesiaRetrospective cohort studyIncidence (epidemiology)MedicineAtrial fibrillationCardiac surgeryArteryCardiologyInternal medicine

摘要: Atrial fibrillation (AF) after cardiac surgery is thought to increase length of stay (LOS). A clinical pathway focused on the management postoperative AF, including prophylaxis with beta blockers, was implemented assess effect AF LOS surgery. Data were obtained consecutive patients in preoperative normal sinus rhythm, no prior history and chronic antiarrhythmic therapy from January May 1995 (control) November 1996 June 1997 (pathway). Statistical analysis performed LOS, outcomes, cost Despite pathway, (7 days for both periods; p = 0.12) incidence (28.9% vs 28.4%; 0.92) remained unchanged. Unadjusted direct costs 15% higher period (p <0.001). Increased rates beta-blocker had a marginal except group who only underwent primary coronary artery bypass graft (31.2% 25.3%; 0.31). Multivariate revealed that contributed 1 1.5 LOS. Thus, this investigation represents most recent effects Unlike studies, impact less prominent current era surgical care regardless presence addressing AF.

参考文章(22)
E. M. Antman, Sharon C Reimold, T. C. Andrews, J. A. Berlin, Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation. ,vol. 84, ,(1991)
William J. Fanning, Clarence S. Thomas, Albert Roach, Richard Tomichek, William C. Alford, William S. Stoney, Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting The Annals of Thoracic Surgery. ,vol. 52, pp. 529- 533 ,(1991) , 10.1016/0003-4975(91)90918-G
Reg Parks, Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery-Reply JAMA: The Journal of the American Medical Association. ,vol. 276, pp. 1719- 1720 ,(1996) , 10.1001/JAMA.1996.03540210027016
Thomas Guarnieri, Shellee Nolan, Sidney O Gottlieb, Audrey Dudek, David R Lowry, Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the amiodarone reduction in coronary heart (ARCH) trial Journal of the American College of Cardiology. ,vol. 34, pp. 343- 347 ,(1999) , 10.1016/S0735-1097(99)00212-0
Lawrence L. Creswell, Richard B. Schuessler, Michael Rosenbloom, James L. Cox, Hazards of postoperative atrial arrhythmias The Annals of Thoracic Surgery. ,vol. 56, pp. 539- 549 ,(1993) , 10.1016/0003-4975(93)90894-N
Piush Gupta, Marcelo E. Helguera, Patrick M. McCarthy, Atrial fibrillation and atrial flutter have no significant impact in intensive care unit and total hospital length of stay after coronary artery bypass grafting Journal of the American College of Cardiology. ,vol. 27, pp. 310- ,(1996) , 10.1016/S0735-1097(96)82140-1
Harold L. Lazar, Carmel Fitzgerald, Stacy Gross, Tim Heeren, Gabriel S. Aldea, Richard J. Shemin, Determinants of Length of Stay After Coronary Artery Bypass Graft Surgery Circulation. ,vol. 92, pp. 20- 24 ,(1995) , 10.1161/01.CIR.92.9.20
H. Martinussen, A. Lolk, C. Szczepanski, P. Alstrup, Supraventricular tachyarrhythmias after coronary bypass surgery--a double blind randomized trial of prophylactic low dose propranolol. Thoracic and Cardiovascular Surgeon. ,vol. 36, pp. 206- 207 ,(1988) , 10.1055/S-2007-1020079
J.Anthony Gomes, John Ip, Francesco Santoni-Rugiu, Davendra Mehta, Arisan Ergin, Steven Lansman, Elena Pe, Teri Takle Newhouse, Sally Chao, Oral d,lsotalol reduces the incidence of postoperative atrial fibrillation in coronary artery bypass surgery patients: a randomized, double-blind, placebo-controlled study☆ Journal of the American College of Cardiology. ,vol. 34, pp. 334- 339 ,(1999) , 10.1016/S0735-1097(99)00213-2