Combined Spinal Epidural and epidural anesthesia decrease the odds of atrial fibrillation after total knee arthroplasty
Eva E. Mörwald MD, Sarah M. Weinstein BA, Crispiana Cozowicz MD, Lila R. Baaklini MD, Lazaros Poultsides MD PhD, Meghan Kirksey MD PhD, Stavros G. Memtsoudis MD PhD FCCP
Introduction: Perioperative atrial Fibrillation (aFib) has been associated with increased morbidity, mortality, length of stay and cost of hospitalization1-3. However, there is a paucity of data detailing risk factors for aFib after non-cardiac and thoracic surgery. Therefore, we aimed to identify predictors and influencing factors for aFib in patients undergoing total knee arthroplasty.
Material and Methods: After approval from the Institutional Review Board we retrospectively analyzed data from patients undergoing total knee arthroplasty at the Hospital for Special Surgery from 2005 to 2014. Variables examined as potentially influencing the odds for developing aFib in multivariate logistic regression models included age, gender, anesthesia type, and comorbidities.
Results: Of N = 21,205 patients n = 1463 (6.8 %) developed aFib. Demographic data and row numbers are presented in Table 1. Older age and male gender as well as preexisting psychosis, sleep apnea, hypertension, congestive heart failure or valvular disease were significantly associated with the development of postoperative aFib as shown in Table 2. Patients with preexisting depression or anxiety had decreased odds (OR 0.67, CI 0.45 – 0.99) for developing aFib. When compared to general anesthesia patients under combined spinal epidural (OR 0.65, CI 0.48 – 0.88) and under epidural anesthesia (OR 0.52, CI 0.32 – 0.85) had significantly decreased odds for developing aFib. Spinal anesthesia alone was not associated with significantly reduced odds for aFib.
Discussion: Atrial fibrillation is a relatively common perioperative complication among patients undergoing total knee arthroplasty. Age, gender, type of anesthesia, cardiopulmonary and psychiatric comorbidities seem to be predicting factors. Specifically, neuraxial anesthesia seems to be associated with a significantly reduced risk for developing aFib among patients undergoing total knee arthroplasty. While other factors can only be used as predictors, the decision to use neuraxial anesthesia instead of general anesthesia might have a relevant beneficial impact on patient outcomes. As this study is ongoing we plan to introduce additional potentially relevant factors such as the use of medications into the model.
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