Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2025; 14(3): 102991
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.102991
Postoperative atrial fibrillation in emergent non-cardiac surgery: Risk factors and outcomes from a ten-year intensive-care unit retrospective study
Dimitrios Giannis, Ruby Zhao, Luis Fernandez, Nicole Nikolov, Christina Sneed, Patrick Kiarie, Andrew Miele, Martine A Louis, Nageswara Rao Mandava
Dimitrios Giannis, Ruby Zhao, Luis Fernandez, Nicole Nikolov, Christina Sneed, Patrick Kiarie, Martine A Louis, Nageswara Rao Mandava, Department of Surgery, Flushing Hospital Medical Center, MediSys Health Network, Flushing, Queens, NY 11355, United States
Andrew Miele, Research, Education & Innovation (REl), MediSys Health Network, Flushing, Queens, NY 11355, United States
Author contributions: Louis MA and Giannis D designed the study and the data interpretation protocol, and drafted the manuscript; Zhao R, Fernandez L, Nikolov N, Sneed C, Kiarie P contributed to data acquisition and interpretation; Miele A was responsible for methodology, data curation, formal analysis and data interpretation; Mandava NR contributed to the design of the study and drafting of the manuscript; all authors read and approved the final version of the manuscript.
Institutional review board statement: The Institutional Review Board (Flushing Hospital Medical Center IRB) has acknowledged and approved this study with an ID: 2107699-1.
Informed consent statement: Informed consent was waived for this retrospective study of de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data of this study are included in the article and summarized in tables. Further requests can be directed to the authors.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Giannis, MD, PhD, Department of Surgery, Flushing Hospital Medical Center, MediSys Health Network, 4500 Parsons Blvd, Flushing, Queens, NY 11355, United States. dimitrisgiannhs@gmail.com
Received: November 5, 2024
Revised: February 25, 2025
Accepted: March 4, 2025
Published online: September 9, 2025
Processing time: 256 Days and 17.3 Hours
Abstract
BACKGROUND

Atrial fibrillation (AF) represents a common arrhythmia with significant implications and may occur pre-, intra-, or postoperatively (POAF). After cardiac surgery POAF occurs in approximately 30% of patients, while non-cardiac/non-thoracic surgery has a reported incidence between 0.4% to 15%, with new onset POAF occurring at a rate of 0.4% to 3%. While AF has been extensively studied, it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting (ICU).

AIM

To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.

METHODS

This retrospective study included patients ≥ 18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU. Data of interest included occurrence of POAF, demographic characteristics, comorbidities, laboratory values, administered fluids, medications, and postoperative outcomes. Statistical analyses consisted of identifying predictors of POAF and associations of POAF with outcomes of interest.

RESULTS

A total of 347 ICU patients were included, 16.4% had a history of AF, 13.0% developed POAF, and 7.9% developed new-onset POAF. Patients with new-onset POAF were older (79.6 ± 9.1 vs 68.1 ± 14.8 years, < 0.001), of white race (47.8% vs 28.8, P < 0.001), hypertensive (87.0% vs 71.2%, P = 0.011), had longer ICU length of stay (ICU-LOS) (13.4 vs 6.7 days, P = 0.042), higher mortality (43.5% vs 17.6%, P = 0.016) and higher rate of cardiac arrest (34.8% vs 14.6%, P = 0.005) compared to patients without new-onset POAF. Multivariable analysis revealed increased POAF risk with advanced age (OR = 1.06; 95%CI: 1.02-1.10, P = 0.005), white race (OR = 2.85; 95%CI: 1.26-6.76, P = 0.014), high intraoperative fluid (OR > 1; 95%CI: 1.00-1.00, P = 0.018), and longer ICU-LOS (OR = 1.04; 95%CI: 1.00-1.08, P = 0.023). After adjusting for demographics, new onset POAF significantly predicted mortality (OR = 3.07; 95%CI: 1.14-8.01, P = 0.022).

CONCLUSION

POAF was associated with prolonged ICU-LOS, white race, and high intraoperative fluid. New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.

Keywords: Postoperative atrial fibrillation; Non-cardiac surgery; Intensive care unit; Postoperative mortality; Emergent surgery; Exploratory laparotomy; Knee amputation

Core Tip: In critically ill patients undergoing emergent non-cardiac surgery, such as exploratory laparotomy or amputation, postoperative atrial fibrillation (POAF) occurred in 13.0% and 7.9% experienced new onset POAF. Factors associated with POAF included advanced age, white race, high intraoperative fluid intake, and prolonged intensive care unit stay. New onset POAF was linked to higher mortality and an increased risk of cardiac arrest. These findings suggest the need for increased awareness of these potential predictors, vigilant monitoring and management in high-risk surgical patients to prevent POAF and associated complications.