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Vessel Plus 2022;6:[Accepted].10.20517/2574-1209.2021.116© The Author(s) 2022
Accepted Manuscript
Open AccessOriginal Article

Postoperative atrial fibrillation is associated with increased resource utilization after cardiac surgery: a regional analysis of the Southeastern United States 

Correspondence Address: Robert B. Hawkins, Cardiac surgery CVC 5144, University of Michigan, Ann Arbor, MI, 48109 USA, United States. E-mail: robertbrucehawkins@gmail.com


© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


Background: Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality following cardiac surgery though contemporary resource utilization data is limited. We hypothesize that POAF increases the length of stay, hospital cost, and discharges to facilities, though this trend may be tempering over time.

Methods: Records were extracted for all patients in a regional database who underwent coronary artery bypass grafting, aortic valve replacement, or both (2012-2020). Patients without a history of atrial fibrillation were stratified by POAF for univariate analysis. Patients were propensity-score matched to account for baseline, operative, and postoperative differences.

Results: Of the 27,307 cardiac surgery patients, 23% developed POAF. Matching resulted in 5926 well-balanced pairs of patients with and without POAF. Every metric of resource utilization was higher for patients with POAF, including ICU length of stay (58 vs. 49 hours, P < 0.0001), postoperative length of stay (7 vs. 5 days, P < 0.0001), discharge to a facility (27% vs. 23%, P < 0.0001), and readmission (11% vs. 8%). The mean additional total hospital cost attributable to POAF was $6,705 by paired analysis. A sensitivity analysis of only patients without major complications demonstrated similarly increased resource utilization for patients with POAF.

Conclusions: POAF was associated with an increased 9 additional ICU hours, 2 postoperative days, 18% more discharges to a facility, and 33% greater readmissions. An additional $6,705 is associated with POAF. These conservative estimates demonstrate the broad impact of POAF on in and out of hospital resource utilization that warrants future efforts at containment and quality improvement.

Cite This Article

Hawkins RB,  Strobel R, Joseph M, Quader M, Teman NR,  Almassi GH,  Mehaffey JH. Postoperative atrial fibrillation is associated with increased resource utilization after cardiac surgery: a regional analysis of the Southeastern United States. Vessel Plus 2022;6:[Accept]. http://dx.doi.org/10.20517/2574-1209.2021.116

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