B. R. Beaulieu-Jones2, E. D. Porter1, K. A. Fay1, E. Diakow2, R. M. Hasson1, T. M. Millington1, D. J. Finley1, J. D. Phillips1 1Dartmouth-Hitchcock,Thoracic Surgery,Lebanon, NH, USA 2Giesel School of Medicine at Dartmouth,Hanover, NH, USA
Introduction: Post-operative atrial fibrillation (POAF) after non-cardiac thoracic surgery is a common complication that is associated with increased morbidity and hospital stay. Most reports review POAF incidence in only anatomic resection; however, the use of non-anatomic (wedge) resections is increasing. Since 2015, our institution has implemented an amiodarone protocol for patients ≥65 years of age undergoing anatomic resection, resulting in a POAF incidence of 9%. We sought to investigate the incidence of POAF in our non-anatomic resection cohort in comparison to our anatomic resection cohort to assess the need for amiodarone prophylaxis following non-anatomic resection.
Methods: Retrospective cohort study at a single tertiary referral center. All anatomic and wedge lung resections from January 2015 through April 2018 were selected. Anatomic resection patients ≥65 years of age, or at the discretion of the Attending Surgeon, were eligible to receive our amiodarone protocol: immediate post-operative IV bolus of 300 mg given over 1 hour followed by 400 mg PO TID x 3days. We excluded patients with chronic atrial fibrillation or a contraindication to amiodarone (hypotension or electrical conduction abnormality). Primary outcome was incidence of POAF within 30 days. We compared anatomic and wedge resection patients using two-sample, two-tailed students t-test and Pearson’s chi-squared test for continuous and categorical data, respectively.
Results: A total of 355 patients underwent lung resection with 85% (300) undergoing an anatomic resection and 15% (55) a wedge resection. On comparative analysis, patients undergoing wedge resection were significantly younger (58.1±17.2 vs. 65.2±9.7 years, p<0.001) and had a shorter duration of surgery (141.4±55.8 vs. 271.2±81.4 mins, p<0.001) than those undergoing anatomic resection. There were no differences with regard to sex, comorbidities, preoperative pulmonary function tests, or length of stay (Table 1). Within wedge resection patients, only 3 received the amiodarone protocol. No wedge resection patients developed POAF. Among patients with anatomic resection, over 89% of patients ≥65 had received amiodarone and POAF occurred in 9% (28) of patients. POAF significantly increased the post-operative length of stay (6.9±4.1 vs. 4.2±4.5 days, p=0.003).
Conclusion: POAF continues to be a challenging problem after non-cardiac thoracic surgery. Amiodarone prophylaxis can reduce the incidence of POAF to 9% among anatomic resections. However, our data indicates that POAF following non-anatomic or wedge resection is rare, and chemoprophylaxis is unnecessary in this population.
