FORT LAUDERDALE, Florida (EGMN) –Patients undergoing lung resection for non–small cell lung cancer had a 13% risk for developing a new atrial arrhythmia in a review of nearly 14,000 patients in a U.S.-wide database involving 111 centers.
This rate confirms prior reports that atrial arrhythmias appeared in 10%-20% of patients following major noncardiac thoracic surgery. But the new finding is the first to be based on data from so many centers, and the first to focus on outcomes after a single type of thoracic surgery – lung resection for cancer – Dr. Mark W. Onaitis said at the annual meeting of the Society of Thoracic Surgeons.
The analysis identified four factors that significantly correlated with an increased risk for developing atrial arrhythmia after lung cancer surgery: more extensive resection (pneumonectomy or bilobectomy compared with lobectomy), increased age, male gender, and more advanced disease (clinical stage II or higher).
The new model could be used “to improve prognostic stratification, and for prospective prophylactic trials,” said Dr. Onaitis, a thoracic surgeon at Duke University in Durham, North Carolina.
Other findings from his analysis focused on the important consequences of atrial arrhythmia. Patients who developed a new-onset arrhythmia had significantly increased mortality; a higher incidence of several major morbidities, including pneumonia and stroke; and a significantly longer hospital stay (see table). During the 30 days following surgery, mortality was 6% in patients who developed an atrial arrhythmia, compared with 2% in those who did not, a significant difference.
The Society of Thoracic Surgeons General Thoracic Surgery Database for 2002-2008 included more than 14,000 patients who had lung resection for non–small cell lung cancer at 111 participating U.S. centers. Excluding patients with atrial arrhythmia prior to surgery left 13,904 patients, of whom 1,755 (13%) developed atrial arrhythmia during the 30 days following surgery.
Multivariate analysis revealed that pnemonectomy doubled the risk for development of atrial arrhythmia compared with lobectomy, while bilobectomy boosted the risk by 67% compared with single lobectomy. Each 10 years of increased age was linked to an 81% increased risk for arrhythmia, and men had a 60% increased risk compared with women. Patients with nodal disease, clinical stage II or greater, had a 28% increased risk for arrhythmia. The analysis also identified one protective feature: African Americans were 38% less likely to develop arrhythmia than were whites. These parameters together accounted for two-thirds of the variance in the rate of new-onset atrial arrhythmias.
Clinical factors that did not significantly correlate with incidence of arrhythmia included the use of a thoracoscopic approach, hypertension, coronary artery disease, heart failure, body mass index, and other racial or ethnic backgrounds.
In an interview, Dr. Malcolm M. DeCamp, Jr, lauded Dr. Onaitis and his colleagues “for leveraging the STS database to begin to dissect this problem (of atrial arrhythmia development following lung resection for cancer).”
Dr. DeCamp, who is chief of the division of cardiothoracic surgery at Beth Israel Deaconess Medical Center in Boston, Massachusetts, said the investigators confirmed the importance of the problem by finding a threefold increase in 30-day mortality in patients who develop perioperative atrial fibrillation.
“Their simplified risk model allows physicians to stratify risk and better counsel patients. Unfortunately, the prognostic factors don’t provide an opportunity to modify the risk. Perhaps the most beneficial outcome of this work will be to identify patients at highest risk who are the best candidates for pharmacologic prophylaxis in the hope of defining a signal of therapeutic efficacy,” he said.
Dr. DeCamp said he had no disclosures relevant to this topic.
