The New Onset of Atrial Arrhythmias Following Major Noncardiothoracic Surgery Is Associated With Increased Mortality

¹ From the Departments of Anesthesiology and Medicine, College of Physicians and Surgeons, Columbia University, New York

Study objectives: To examine the incidence and consequences of atrial arrhythmias in surgical ICU patients following major noncardiac, nonthoracic surgery.

Design: Prospective observational study.

Setting: University hospital surgical ICU.

Patients: Four hundred sixty-two consecutive patients after noncardiothoracic surgery.

Interventions: None.

Measurements and results: Patients were assigned to one of three groups: group 1-new-onset atrial arrhythmias (n=47); group 2-history of atrial arrhythmias (n=58); and group 3-no atrial arrhythmias (n=357). New arrhythmias occurred in 10.2% of patients. Most began within the first 2 postoperative days. These patients had a higher mortality rate (23.4%), longer ICU stay (8.5±17.4 [SD] days), and extended hospital stay (23.3±23.6 days) than patients without atrial arrhythmias (mortality, 4.3%; ICU stay, 2.0±4.5 days; hospital stay; 13.3±17.7 days; p<0.02). Thirteen percent of patients had a history of atrial arrhythmias. They had a higher mortality rate (8.6%) and longer ICU stays (2.9±4.9 days; p<0.02) than patients without arrhythmias. Most deaths in the two arrhythmia groups were not due to cardiac problems, but to sepsis or cancer.

Conclusions: Patients admitted to a surgical ICU after noncardiothoracic surgery with a history of or who developed new atrial arrhythmias had greater mortality and longer ICU stays than patients without arrhythmias. The incidence of new-onset arrhythmias was lower than reported after cardiac and thoracic surgery, but higher than in the general population. Atrial arrhythmias were not the cause of death and appear to be markers of increased mortality and morbidity.

Key Words: abdominal surgery • atrial arrhythmias • atrial fibrillation • critical care • intensive care unit • left atrial enlargement • length of stay • noncardiac surgery • postoperative complications • supraventricular tachycardia

Submitted on April 14, 1997
Accepted on January 13, 1998

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