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J Thorac Cardiovasc Surg 2003;126:1162-1167
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality

^a Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
^b Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Received for publication December 7, 2001; revisions received April 23, 2002; revisions received August 22, 2002; accepted for publication June 22, 2003.

^* Address for reprints: John Wong, PhD, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
jwong{at}hku.hk

OBJECTIVE: Postoperative atrial fibrillation complicates recovery in 20% to 25% of patients after esophagectomy for cancer. The purpose of this study is to understand this phenomenon.

METHODS: Between 1982 and 2000, 198 (22% of 921) patients had postoperative atrial fibrillation after esophagectomy. Propensity scoring and the Greedy Match algorithm were used to develop a cohort of control patients for statistical comparisons. One hundred forty-four patients who had postoperative atrial fibrillation were matched.

RESULTS: Pulmonary complications affected 42% of patients in the atrial fibrillation group compared with 17% in the control group (P < .001). Anastomotic leakage was more common in the atrial fibrillation group (6.9% vs 1.4%, P = .035). Surgical sepsis migrated with atrial fibrillation 4 times more frequently (P = .001). Multivariate analysis demonstrated that postoperative pulmonary complications (odds ratio, 2.5; 95% confidence interval, 1.42-4.3) and surgical sepsis (odds ratio, 3.4; 95% confidence interval, 1.2-9.6) were associated with postoperative atrial fibrillation. The mortality rates of the atrial fibrillation and control groups were 23% and 6.3%, respectively (P < .001). Median survival, excluding hospital deaths, was not different at 14.5 months (atrial fibrillation group) and 16.9 months (control group; P = .4).

CONCLUSION: Atrial fibrillation is a surrogate for surgical morbidity and mortality after esophagectomy. The occurrence of atrial fibrillation after esophageal resection should prompt not only the appropriate management of the arrhythmia but also a search for a more ominous underlying cause.

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