Postoperative atrial fibrillation following non-cardiac surgery: Predictors and risk of mortality


      • Between 2010 and 2015 the incidence of non-cardiac surgery POAF is decreasing.
      • Age, gender, type of surgery are independent risk factors for development of POAF.
      • Race is an independent determinant of mortality following POAF.
      • Socioeconomic factors are independent determinants of mortality following POAF.
      • Socioeconomic factors are not associated with development of POAF.



      Postoperative atrial fibrillation (POAF) is a major complication that follows both cardiac and non-cardiac procedures. Many studies have explored POAF after cardiac procedures, however POAF following non-cardiac procedures has been understudied.


      National Inpatient Sample database was utilized to conduct a retrospective study of hospitalizations with diagnosis of POAF following non-cardiac procedures between 2010 and 2015.


      294,112 patients met the inclusion criteria. Advanced age, male gender, colonic resections, coagulopathy, fluid and electrolyte disorders and history of congestive heart failure are major predictors of POAF and in-hospital mortality. Race, type of insurance, income quartile and weekend admissions are independent determinants of mortality following POAF.


      Development of POAF and mortality is dependent upon a wide range of factors not limited to age and medical comorbidities. Although a patient may be at an increased risk for POAF this does not mean they are at an increased risk for mortality.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Creswell L.L.
        • Schuessler R.B.
        • Rosenbloom M.
        • Cox J.L.
        Hazards of postoperative atrial arrhythmias.
        Ann Thorac Surg. 1993; 56
        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • et al.
        Prevalence of diagnosed atrial fibrillation in adults.
        JAMA. 2001; 285
        • Bhave P.D.
        • Goldman L.E.
        • Vittinghoff E.
        • Maselli J.
        • Auerbach A.
        Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery.
        Am Heart J. 2012; 164
        • Rena O.
        Supraventricular arrhythmias after resection surgery of the lung.
        Eur J Cardio Thorac Surg. 2001; 20
        • AlTurki A.
        • Marafi M.
        • Proietti R.
        • et al.
        Major adverse cardiovascular events associated with postoperative atrial fibrillation after noncardiac surgery.
        Circulation: Arrhythmia Electrophysiol. 2020; 13
        • Amar D.
        • Roistacher N.
        • Rusch V.W.
        • et al.
        Effects of diltiazem prophylaxis on the incidence and clinical outcome of atrial arrhythmias after thoracic surgery.
        J Thorac Cardiovasc Surg. 2000; 120
        • Bourgon Labelle J.
        • Farand P.
        • Vincelette C.
        • Dumont M.
        • le Blanc M.
        • Rochefort C.M.
        Validation of an algorithm based on administrative data to detect new onset of atrial fibrillation after cardiac surgery.
        BMC Med Res Methodol. 2020; 20
        • Simmers D.
        • Potgieter D.
        • Ryan L.
        • Fahrner R.
        • Rodseth R.N.
        The use of preoperative B-type natriuretic peptide as a predictor of atrial fibrillation after thoracic surgery: systematic review and meta-analysis.
        J Cardiothorac Vasc Anesth. 2015; 29
        • Kotova S.
        • Wang M.
        • Lothrop K.
        • Grunkemeier G.
        • Merry H.E.
        • Handy J.R.
        CHADS 2 score predicts postoperative atrial fibrillation in patients undergoing elective pulmonary lobectomy.
        Ann Thorac Surg. 2017; 103
        • Vaporciyan A.A.
        • Correa A.M.
        • Rice D.C.
        • et al.
        Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients.
        J Thorac Cardiovasc Surg. 2004; 127
        • Amar D.
        • Zhang H.
        • Leung Dh Y.
        • Roistacher N.
        • Kadish A.H.
        Older age is the strongest predictor of postoperative atrial fibrillation.
        Anesthesiology. 2002; 96
        • Bouchot O.
        • Guenancia C.
        • Kahli A.
        • et al.
        Low circulating levels of growth differentiation factor-15 before coronary artery bypass surgery may predict postoperative atrial fibrillation.
        J Cardiothorac Vasc Anesth. 2015; 29
        • Saskin H.
        • Serhan Ozcan K.
        • Yilmaz S.
        High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting.
        Interact Cardiovasc Thorac Surg. 2016; 31 (Published online December)
        • Dun W.
        • Boyden P.A.
        Aged atria: electrical remodeling conducive to atrial fibrillation.
        J Intervent Card Electrophysiol. 2009; 25
        • Hernández-Romero D.
        • Vílchez J.A.
        • Á Lahoz
        • et al.
        Galectin-3 as a marker of interstitial atrial remodelling involved in atrial fibrillation.
        Sci Rep. 2017; 7
        • Tada H.
        • Sticherling C.
        • Chough S.P.
        • et al.
        Gender and age differences in induced atrial fibrillation.
        Am J Cardiol. 2001; 88
        • Larsen J.A.
        • Kadish A.H.
        Effects of gender on cardiac arrhythmias.
        J Cardiovasc Electrophysiol. 1998; 9
        • Fernando H.C.
        • Jaklitsch M.T.
        • Walsh G.L.
        • et al.
        The society of thoracic surgeons practice guideline on the prophylaxis and management of atrial fibrillation associated with general thoracic surgery: executive summary.
        Ann Thorac Surg. 2011; 92
        • Chung M.K.
        • Martin D.O.
        • Sprecher D.
        • et al.
        C-reactive protein elevation in patients with atrial arrhythmias.
        Circulation. 2001; 104
        • Angele M.K.
        • Schwacha M.G.
        • Ayala A.
        • Chaudry I.H.
        Effect of gender and sex hormones on immune responses following SHOCK.
        Shock. 2000; 14
        • Siu C.W.
        • Tung H.M.
        • Chu K.W.
        • Jim M.H.
        • Lau C.P.
        • Tse H.F.
        Prevalence and predictors of new-onset atrial fibrillation after elective surgery for colorectal cancer.
        Pacing Clin Electrophysiol. 2005; 28
        • Rader F.
        • van Wagoner D.R.
        • Ellinor P.T.
        • et al.
        Influence of race on atrial fibrillation after cardiac surgery.
        Circulation: Arrhythmia Electrophysiol. 2011; 4
        • Tanabe K.
        • Yamaguchi K.
        • Tani T.
        • et al.
        Left atrial volume: predictor of atrial fibrillation in patients with degenerative mitral regurgitation.
        J Heart Valve Dis. 2007; 16
        • Marcus G.M.
        • Olgin J.E.
        • Whooley M.
        • et al.
        Racial differences in atrial fibrillation prevalence and left atrial size.
        Am J Med. 2010; 123
        • Soliman E.Z.
        • Alonso A.
        • Goff D.C.
        Atrial fibrillation and ethnicity: the known, the unknown and the paradox.
        Future Cardiol. 2009; 5
        • Deol P.S.
        • Sipko J.
        • Kumar A.
        • et al.
        Effect of insurance type on perioperative outcomes after robotic-assisted pulmonary lobectomy for lung cancer.
        Surgery. 2019; 166
        • Peberdy M.A.
        Survival from in-hospital cardiac arrest during nights and weekends.
        JAMA. 2008; 299
        • Wyse D.G.
        • van Gelder I.C.
        • Ellinor P.T.
        • et al.
        Lone atrial fibrillation: does it exist?.
        J Am Coll Cardiol. 2014; 63
        • Packer M.
        Epicardial adipose tissue may mediate deleterious effects of obesity and inflammation on the myocardium.
        J Am Coll Cardiol. 2018; 71
        • Dobrev D.
        • Aguilar M.
        • Heijman J.
        • Guichard J.B.
        • Nattel S.
        Postoperative atrial fibrillation: mechanisms, manifestations and management.
        Nat Rev Cardiol. 2019; 16
        • Bessissow A.
        • Khan J.
        • Devereaux P.J.
        • Alvarez-Garcia J.
        • Alonso-Coello P.
        Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview.
        J Thromb Haemostasis : JTH. 2015; 13
        • Smith H.
        • Yeung C.
        • Gowing S.
        • et al.
        A review and analysis of strategies for prediction, prevention and management of post-operative atrial fibrillation after non-cardiac thoracic surgery.
        J Thorac Dis. 2018; 10
        • Zhao B.C.
        • Huang T.Y.
        • Deng Q.W.
        • et al.
        Prophylaxis Against atrial fibrillation after general thoracic surgery.
        Chest. 2017; 151
        • Bessissow A.
        • Agzarian J.
        • Shargall Y.
        • et al.
        Colchicine for Prevention of Perioperative Atrial Fibrillation in patients undergoing lung resection surgery: a pilot randomized controlled study.
        Eur J Cardio Thorac Surg : Off J Eur Assoc Cardio Thorac Surg. 2018; 53
      1. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial.
        Lancet. 2008; 371
        • Yoshihara H.
        • Yoneoka D.
        Understanding the statistics and limitations of large database analyses.
        Spine. 2014; 39