Perioperative Inflammatory Response is Associated with New-Onset Postoperative Atrial Fibrillation after Robotic-Assisted Pulmonary Lobectomy
Gregory Fishberger1, Diep Nguyen1, Jessica Cobb1, Harrison Strang1, Collin Chase1, Ajay Varadhan1, Maykel Dolorit1, Mudit Dutta1, Sarah Cool1, Emily Weeden1, Rahul Mhaskar1, Joseph R. Garrett2, Carla C. Moodie2, Jacques Fontaine2, Jenna Tew2, Jobelle J.A.R. Baldonado2, Eric M. Toloza2.
1University of South Florida Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA.
OBJECTIVE: Postoperative atrial fibrillation (POAF) is a common surgical complication that negatively impacts both recovery and long-term outcomes. We analyzed the characteristics of patients who developed new-onset POAF after undergoing robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.
METHODS: We retrospectively analyzed 710 patients who underwent RAVT pulmonary lobectomy by one surgeon over 10.7 years. After 130 patients were excluded due to preoperative history of atrial fibrillation or use of steroids or immunosuppressants, 580 patients were grouped based on the presence or absence of new-onset POAF. Age, body mass index (BMI), NSAID use, perioperative white blood cell (WBC) count, chest tube duration, and hospital length of stay (LOS) were compared by t-test, Chi-squared, and Kruskal-Wallis tests, with p≤0.05 as significant.
RESULTS: Of 580 study patients, 78 patients developed new-onset POAF. On average, patients who developed new-onset POAF were older (p<0.001), had longer chest tube duration (p<0.001), and had longer LOS (p<0.001). Peak postoperative WBC count was higher in the new-onset POAF group (p=0.0356), but BMI and NSAID use were not significantly different between groups. Multivariable analysis found new-onset POAF and peak postoperative WBC to be significant independent predictors of increased LOS (p<0.001) (See Table 1).
CONCLUSIONS: Elevated peak postoperative leukocyte counts are associated with new-onset POAF, which complicates the clinical course during recovery after RAVT pulmonary lobectomy and may forecast increased LOS. However, perioperative NSAID use is not associated with, and possibly mitigates, an increased incidence of new-onset POAF and may provide insight into possible prophylaxis or treatment of new-onset POAF.
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