Transthoracic approach is associated with increased incidence of atrial fibrillation after esophageal resection

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• 作者：Kush R. Lohani ; Kalyana C. Nandipati ; Sarah E. Rollins…
• 关键词：Transthoracic esophagectomy ; Transhiatal esophagectomy ; New ; onset atrial fibrillation
• 刊名：Surgical Endoscopy
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：29
• 期：7
• 页码：2039-2045
• 全文大小：418 KB
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  7.Vaporciyan AA, Correa AM, Rice DC, Roth JA, Smythe WR, Swisher SG, Walsh GL, Putnam JB Jr (2004) Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg 127(3):779-86PubMed View Article
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  9.Park YJ, Yoon JW, Kim KI, Lee YJ, Kim KW, Choi SH, Lim S, Choi DJ, Park KH, Choh JH, Jang HC, Kim SY, Cho BY, Lim C (2009) Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg 87(6):1846-852. doi:10.-016/?j.?athoracsur.-009.-3.-32 PubMed View Article
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  20.Saran T, Perkins GD, Javed MA, Annam V, Leong L, Gao F, Stedman R (2011) Does the prophylactic administration of magnesium sulphate to patients undergoing thoracotomy prevent postoperative supraventricular arrhythmias? A randomized controlled trial. Br J Anaesth 106(6):785-91PubMed View Article
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• 作者单位：Kush R. Lohani (1)
  Kalyana C. Nandipati (1)
  Sarah E. Rollins (1)
  Katharina Fetten (1)
  Tommy H. Lee (1)
  Pradeep K. Pallati (1)
  Se Ryung Yamamoto (1)
  Sumeet K. Mittal (1)
  
  1. Department of Surgery, Creighton University School of Medicine, Omaha, NE, 68131, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gynecology
  Gastroenterology
  Hepatology
  Proctology
  Abdominal Surgery
  
• 出版者：Springer New York
• ISSN：1432-2218

文摘

Aim Atrial fibrillation (AF) has been associated with higher morbidity after esophagectomy. The objective of this study is to identify the surgical risk factors associated with new-onset atrial fibrillation after esophagectomy. Methods After Institutional Review Board approval, a prospectively maintained database was retrospectively queried to identify patients who underwent esophagectomy between 2003 and 2013. Data variables collected include pre-operative, intra-operative, and post-operative factors. Appropriate statistical analysis is performed utilizing Sigmaplot? version 12.3. Results From 2003 to 2013, 245 esophagectomies were performed at our institution, of these, 192 (147 males, mean age of 62?±?11.12?years) were included in the final analysis and 53 were excluded [25 Roux-en-Y reconstruction (including three Merendino procedures), 20 had AF before surgery, and eight with staged esophagectomy]. Of 192 esophagectomies, 160 had malignancy (138 adenocarcinoma and 22 squamous cell carcinoma) and 106 (66.25?%) received neo-adjuvant therapy. Esophagectomies were performed with Ivor Lewis Mckeown approach in 78 patients [34 Minimally Invasive (MIE), 37 open, and 7 Hybrid], Ivor Lewis approach in 56 patients (31 MIE, 10 Open, 15 Hybrid) and Transhiatal approach in 58 patients (16 MIE and 42 Open). Gastric conduit was used in 185 patients and colonic conduit in seven patients. Overall 30-day or in-hospital mortality was 3.6?% (7/192). Forty-five (23.4?%) patients with esophagectomy developed new-onset AF. Median onset of AF was post-op day 3 (0-2). They were older (65.7 vs. 61.3, p?=?0.021), with medical comorbidities (thyroid disorder, hyperlipidemia, and coronary artery disease; p?<?0.05) and lower diffusion capacity on Pulmonary function test (80.16 vs. 87.74?%, p?=?0.02) and stayed longer in hospital (19 vs. 14?days, p?<?0.001) with severe post-operative complications (Clavien score?≥?III) (69 vs. 35.3?%, p?<?0.001). Multiple logistic regression analysis showed transthoracic approach (OR?=?3.71, CI?=?1.23-1.17, p?=?0.02) and thyroid disorder (OR?=?6.29, CI?=?1.54-5.65, p?=?0.01), and severe post-op complications (OR?=?3.34, CI?=?1.20-.28, p?=?0.02) were significantly associated with the development of new-onset AF. Conclusions Transthoracic approach is an independent risk factor for the development of new-onset AF after esophagectomy. New-onset AF is associated with severe post-operative complications and longer hospital stay. Minimally invasive approach does not decrease the incidence of new-onset AF.