Background: Although perioperative atrial fibrillation is believed to be self-limited, several studies have shown an association between perioperative atrial fibrillation and higher risk of perioperative stroke and mortality.
Objectives: To perform a systematic review and meta-analysis to - 1) comprehensively evaluate the qualitative and quantitative relationships of perioperative atrial fibrillation with subsequent risk of stroke and mortality; 2) assess any differences in outcomes among major subgroups.
Methods: We searched PudMed and EMBASE for articles published from 1966 to December 2016. We included studies that assessed and reported quantitative estimates of the multivariate adjusted hazard ratio (HR) and 95% confidence interval (CI) for subsequent stroke and mortality associated with perioperative or postoperative atrial fibrillation, or both. We excluded studies that had a cross-sectional or case-control design, that included patients with preexisting atrial fibrillation before surgery, and that did not report 95% CI.
Result: There were eight articles included in our primary analysis: three articles included both stroke and mortality as endpoints, four articles only assessed mortality, and one article only evaluated stroke. Pooling results using a random-effect model showed an association between perioperative atrial fibrillation and both subsequent stroke risk (HR, 1.6; 95% CI, 1.3-2.0) and mortality risk (HR, 1.3; 95% CI, 1.2-1.3) (Figure). In subgroup analyses, the association between perioperative atrial fibrillation and stroke was stronger in patients who underwent non-cardiac surgery (HR, 2.0; 95% CI, 1.8-2.3) than in those who received cardiac surgery (HR, 1.5; 95% CI, 1.2-1.8).
Conclusions: New onset perioperative atrial fibrillation is associated with an increased risk of both stroke and mortality. This association is stronger among those undergoing non-cardiac surgery than cardiac surgery.