Impact of atrial fibrillation on long-term survival following oesophagectomy: a 21-year observational study.

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.