Atrial fibrillation complicating lung cancer resection

Abstract

Objective: To (1) characterize atrial fibrillation complicating lung cancer resection, (2) evaluate its temporal relationship to other postoperative complications, and (3) assess its economics.

Methods: From January 1998 to August 2002, 604 patients underwent anatomic lung cancer resection. Atrial fibrillation prevalence, onset, and temporal associations with other postoperative complications were determined. Propensity matching was used to assess economics.

Results: Atrial fibrillation occurred in 113 patients (19%), peaking on postoperative day 2. Older age, male gender, heart failure, clamshell incision, and right pneumonectomy were risk factors (P < .01). Although atrial fibrillation was solitary in 75 patients (66%), other postoperative complications occurred in 38. Respiratory and infectious complications were temporally linked with atrial fibrillation onset. In 91 propensity-matched pairs, patients developing atrial fibrillation had more other postoperative complications (30% vs. 9%, P < .0004), had longer postoperative stays (median 8 vs 5 days, P < .0001), incurred higher costs (cost ratio 1.8, 68% confidence limits 1.6-2.1), and had higher in-hospital mortality (8% vs 0%, P = .01). Even when atrial fibrillation was a solitary complication, hospital stay was longer (median 7 vs 5 days, P < .0001), and cost was higher (cost ratio 1.5, 68% confidence limits 1.2-1.6).

Conclusion: Atrial fibrillation occurs in 1 in 5 patients after lung cancer resection, with peak onset on postoperative day 2. Risk factors are both patient and procedure related, and atrial fibrillation may herald other serious complications. Although often solitary, atrial fibrillation is associated with longer hospital stay and higher cost. It therefore requires prompt treatment and should stimulate investigation for other problems.