1. Preoperative CHA2DS2-VASc Score Predicts Postoperative Atrial Fibrillation after Lobectomy.
- Author
-
Lee CT, Strauss DM, Stone LE, Stoltzfus JC, Puc MM, and Burfeind WR
- Subjects
- Age Factors, Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Carcinoma, Non-Small-Cell Lung pathology, Clinical Decision-Making, Comorbidity, Databases, Factual, Female, Health Status, Humans, Lung Neoplasms pathology, Male, Middle Aged, Pennsylvania, Pneumonectomy methods, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Risk Factors, Sex Factors, Treatment Outcome, Atrial Fibrillation etiology, Carcinoma, Non-Small-Cell Lung surgery, Decision Support Techniques, Lung Neoplasms surgery, Pneumonectomy adverse effects, Thoracic Surgery, Video-Assisted adverse effects
- Abstract
Background: Postoperative atrial fibrillation (POAF) affects 10 to 20% of noncardiac thoracic surgeries and increases patient morbidity and costs. The purpose of this study is to determine if preoperative CHA
2 DS2 -VASc score can predict POAF after pulmonary lobectomy for nonsmall cell lung cancer., Methods: Patients with complete CHA2 DS2 -VASc data who underwent lobectomies from January 2007 to January 2016 at a single institution were analyzed in a retrospective case-control study using a prospective database. An independent samples t -test was used to compare the mean CHA2 DS2 -VASc scores of POAF and non-POAF groups. A multivariable logistic regression analysis (MVA) evaluated the independent contribution of variables of the CHA2 DS2 -VASc score in predicting POAF. Chi-square test with univariate odds ratios (ORs) was used to determine a statistically significant cutoff score for predicting POAF., Results: Of 525 total patients, 82 (15.6%) developed POAF (mean CHA2 DS2 -VASc score: 2.7) and 443 (84.4%) did not develop POAF (mean score: 2.3). Mean difference between these groups was significant at 0.43 ( p = 0.01; 95% confidence interval [CI]: 0.09-0.76). In the MVA, significant predictors of POAF were age 65 to 74 years (adjusted OR [aOR] = 2.45; 95% CI: 1.31-4.70; p = 0.006) and age ≥75 years (aOR = 3.11; 95% CI: 1.62-5.95; p = 0.0006). Patients with CHA2 DS2 -VASc scores ≥5 had significantly increased OR for POAF (OR = 2.59; 95% CI: 1.22-5.50)., Conclusions: Preoperatively calculated CHA2 DS2 -VASc score can predict POAF in patients undergoing pulmonary lobectomy. Age is the most statistically significant independent predictor, and patients with scores ≥5 have significantly increased risk. Trials for POAF prophylaxis should target this population., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)- Published
- 2019
- Full Text
- View/download PDF