The Thoracic and Cardiovascular Surgeon | 2019
Preoperative CHA2 DS2‐VASc Score Predicts Postoperative Atrial Fibrillation after Lobectomy
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 CHA2 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.