Research
Preoperative levels of natriuretic peptides and the incidence of postoperative atrial fibrillation after noncardiac surgery: a prospective cohort study
Wojciech Szczeklik, Yannick LeManach, Jakub Fronczek, Kamil Polok, David Conen, Finlay A. McAlister, Sadeesh Srinathan, Pablo Alonso-Coello, Bruce Biccard, Emmanuelle Duceppe, Diane Heels-Ansdell, Jacek Górka, Shirley Pettit, Pavel S. Roshanov and P.J. Devereaux
CMAJ December 07, 2020 192 (49) E1715-E1722; DOI: https://doi.org/10.1503/cmaj.200840
Wojciech Szczeklik
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDYannick LeManach
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDJakub Fronczek
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MDKamil Polok
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MDDavid Conen
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MDFinlay A. McAlister
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDSadeesh Srinathan
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDPablo Alonso-Coello
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDBruce Biccard
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDEmmanuelle Duceppe
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MDDiane Heels-Ansdell
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MScJacek Górka
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MDShirley Pettit
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MScPavel S. Roshanov
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
MDP.J. Devereaux
Department of Intensive Care and Perioperative Medicine (Szczeklik, Fronczek, Polok, Górka), Jagiellonian University Medical College, Kraków, Poland; Population Health Research Institute (LeManach, Conen, Duceppe, Pettit, Devereaux) and Department of Health Research Methods, Evidence, and Impact (LeManach, Conen, Heels-Ansdell), McMaster University, Hamilton, Ont.; Division of General Internal Medicine, Department of Medicine (McAlister), University of Alberta, Edmonton, Alta.; Department of Surgery (Srinathan), University of Manitoba, Winnipeg, Man.; Iberoamerican Cochrane Center (Alonso-Coello), Biomedical Research Institute Sant Pau (IIB-Sant Pau-CIBERESP), Barcelona, Spain; Department of Anaesthesia and Perioperative Medicine (Biccard), Groote Schuur Hospital and University of Cape Town, South Africa; Division of Nephrology (Roshanov), Department of Medicine, London Health Sciences Centre, London, Ont.
PhDTable 1:
Characteristic | No. (%) of patients without POAF within 30 d after surgery† n = 37 295 | No. (%) of patients with POAF within 30 d after surgery† n = 369 | p value for difference |
---|---|---|---|
Age, yr; mean ± SD | 63.4 ± 11.1 | 73.1 ± 10.2 | < 0.001 |
Female | 18 724 (50.2) | 169 (45.8) | 0.09 |
Frail‡ | 2052 (5.5) | 36 (9.8) | 0.001 |
Smoking history | |||
Current smoker | 20 069 (53.9) | 143 (38.8) | < 0.001 |
Former smoker | 11 916 (32.0) | 182 (49.3) | |
Medical history | |||
Coronary artery disease | 4250 (11.4) | 68 (18.4) | < 0.001 |
Recent high-risk CAD | 310 (0.8) | 3 (0.8) | > 0.99 |
Congestive heart failure | 895 (2.4) | 17 (4.6) | 0.02 |
Aortic stenosis | 283 (0.8) | 10 (2.7) | < 0.001 |
Peripheral vascular disease | 2759 (7.4) | 44 (11.9) | 0.002 |
History of CVE | 2134 (5.7) | 38 (10.3) | < 0.001 |
History of DVT/PE | 1150 (3.1) | 11 (3.0) | > 0.99 |
Hypertension | 18 197 (48.8) | 247 (66.9) | < 0.001 |
Diabetes | 7657 (20.5) | 73 (19.8) | 0.8 |
Chronic obstructive pulmonary disease | 2683 (7.2) | 62 (16.8) | < 0.001 |
Obstructive sleep apnea | 1743 (4.7) | 18 (4.9) | 0.8 |
Preoperative medications ≤ 24 h before surgery | |||
β-blockers | 5386 (14.5) n =37 260 | 71 (19.2) n = 369 | 0.01 |
Rate-controlling calcium channel blocker | 694 (1.9) n = 37 264 | 12 (3.3) n = 369 | 0.08 |
Preoperative medications > 24 h to 7 d before surgery | |||
β-blockers | 6032 (16.2) | 84 (22.8) | 0.001 |
Rate-controlling calcium-channel blocker | 819 (2.2) | 15 (4.1) | 0.03 |
Urgent/emergent surgery | 3792 (10.2) | 62 (16.8) | < 0.001 |
Surgery | |||
Thoracic surgery | 1053 (2.8) | 35 (9.5) | |
Major nonthoracic surgery | 22 502 (60.3) | 306 (82.9) | < 0.001 |
Other surgeries | 13 740 (36.8) | 28 (7.6) | |
Type of anesthesia | |||
General anesthesia | 22 961 (61.7) | 187 (50.7) | |
Regional anesthesia | 10 145 (27.2) | 75 (20.3) | < 0.001 |
Combined general and regional anesthesia | 4137 (11.1) | 107 (29.0) | |
Preoperative hemoglobin, g/L | |||
Mean ± SD | 130.4 ± 19.4 n = 35 978 | 125.8 ± 21.1 n = 364 | |
Median (IQR) | 132 (120–143) n = 35 978 | 128 (113–140) n = 364 | < 0.001 |
Preoperative eGFR, mL/min/1.73 m2 | |||
Mean ± SD | 80.5 ± 24.2 n = 34 696 | 68.6 ± 25.4 n = 361 | |
Median (IQR) | 84.7 (67.8–97.2) n = 34 696 | 73.3 (52.2–88.3) n = 361 | < 0.001 |
Note: CAD = coronary artery disease, CHF = congestive heart failure, CVE = cerebrovascular events, DVT/PE = deep venous thrombosis/pulmonary embolism, eGFR = estimated glomerular filtration rate, IQR = interquartile range, POAF = postoperative atrial fibrillation, SD = standard deviation.
↵* All outcome definitions are available in Appendix 2. When data are missing, denominators are specified.
↵† Unless specified otherwise.
↵‡ We defined “frail” as a person living in a assisted living facility or who requires assistance with activities of daily living.
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Preoperative levels of natriuretic peptides and the incidence of postoperative atrial fibrillation after noncardiac surgery: a prospective cohort study
Wojciech Szczeklik, Yannick LeManach, Jakub Fronczek, Kamil Polok, David Conen, Finlay A. McAlister, Sadeesh Srinathan, Pablo Alonso-Coello, Bruce Biccard, Emmanuelle Duceppe, Diane Heels-Ansdell, Jacek Górka, Shirley Pettit, Pavel S. Roshanov, P.J. Devereaux
CMAJ Dec 2020, 192 (49) E1715-E1722; DOI: 10.1503/cmaj.200840
Preoperative levels of natriuretic peptides and the incidence of postoperative atrial fibrillation after noncardiac surgery: a prospective cohort study
Wojciech Szczeklik, Yannick LeManach, Jakub Fronczek, Kamil Polok, David Conen, Finlay A. McAlister, Sadeesh Srinathan, Pablo Alonso-Coello, Bruce Biccard, Emmanuelle Duceppe, Diane Heels-Ansdell, Jacek Górka, Shirley Pettit, Pavel S. Roshanov, P.J. Devereaux
CMAJ Dec 2020, 192 (49) E1715-E1722; DOI: 10.1503/cmaj.200840
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