Morbidity and mortality with atrial fibrillation following colorectal surgery.

Post-operative atrial fibrillation (POAF) is a common, self-limiting complication following non-cardiac surgery. It is associated with other complications such as pneumonia and sepsis, increased hospital stay and in-hospital mortality. The aim of the study is to identify risk factors, morbidity and mortality associated with POAF.

METHODS: Retrospective cohort study of 571 consecutive patients who presented for colorectal surgery at The Canberra Hospital. Seventy-four patients were excluded due to history of atrial fibrillation and a further 124 patients were lost to follow-up at 1 year. Patient characteristics, intraoperative factors and post-operative outcomes were retrospectively collected. One-year mortality data were collected for 373 patients in the cohort.

RESULTS: A total of 497 patients were included, 33 (6.6%) developed POAF within 30 days of surgery. POAF is associated with ischaemic heart disease (24.2 versus 11.6%, P = 0.035), emergency (66.7 versus 34.1%, P = 0.0001) and open procedures (87.9 versus 70.9%, P = 0.036). There is a higher incidence of post-operative complications including pneumonia (24.2 versus 9.1%, P = 0.006), abdominal collection (21.2 versus 9.7%, P = 0.049) and sepsis (21.2 versus 7.5%, P < 0.0001). POAF had a higher in-hospital mortality (9.1 versus 2.6%, P = 0.035) and 1-year mortality (33.3 versus 8.8%, P < 0.0001).

CONCLUSION: POAF is a common presentation following colorectal surgery and is associated with infective complications, reflecting an inflammatory process. Risk factors for POAF have been clearly identified in the literature; however, further studies need to be conducted on preventative strategies. There is a significantly higher 1-year mortality rate compared with the controls, the aetiology of which has not yet been widely reviewed.