Abstract
OBJECTIVE: New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) is common. Additional information regarding long-term clinical and financial outcomes is important. This statewide analysis compares periprocedural and long-term outcomes between patients with and without POAF. METHODS: Data on patients who underwent isolated CABG from 2013 to 2021 without atrial fibrillation (AF) history from a statewide Society of Thoracic Surgeons database (N = 18,377) were merged with the state health services database. Patients with POAF (n = 4656) were compared with those without POAF (n = 13,721). Outcomes were incidence and cost of readmissions, examined with χ(2) tests and regressions. RESULTS: The incidence of POAF was 25% (male = 26% vs female = 24%, P = .002). Patients with POAF had worse risk-adjusted outcomes, more often were discharged on oral anticoagulation (29% vs 7%, P < .001), and incurred greater procedural cost ($52K vs $46K, P < .001). The POAF group had a greater incidence of readmissions for AF (12% vs 3%, P < .001), heart failure (HF) (15% vs 10%, P < .001), and major bleeding (2.4% vs 1.6%, P = .001) but not ischemic stroke (5% vs 4%, P = .100). After risk adjustment, POAF remained at greater risk for AF, HF, and major bleeding readmissions. The proportion of patients' readmission costs associated with AF (11% vs 3%, P < .001), HF (12% vs 9%, P < .001), and major bleeding (2.1% vs 1.4%, P = .009) was greater for patients with POAF but not ischemic stroke (4% vs 4%, P = .591). CONCLUSIONS: POAF remains common after CABG, with greater cost and risk-adjusted morbidity reported. Follow-up data reveal a significant number of patients continue to be impacted by AF. This study suggests targeted discharge planning and surveillance for patients with POAF to improve long-term outcomes and reduce cost of complications.