Universität zu Köln

Torabi, Saeed ORCID: 0000-0003-0646-0465, Omuro, Philipp ORCID: 0009-0000-4907-1852, Dusse, Fabian ORCID: 0000-0001-7762-6966, Wirsik, Naita M. ORCID: 0000-0003-1619-6354, Schmidt, Thomas ORCID: 0000-0002-7166-3675, Schröder, Wolfgang ORCID: 0000-0002-8700-069X, Kammerer, Tobias ORCID: 0000-0001-8920-7187, Steinbicker, Andrea U. ORCID: 0000-0002-5237-961X, Schlößer, Hans A. ORCID: 0000-0002-1304-7719, Bruns, Christiane J. ORCID: 0000-0001-6590-8181, Fuchs, Hans F. ORCID: 0000-0003-4764-8050 and Schiffmann, Lars M. ORCID: 0000-0002-2320-5004 (2025). The impact of postoperative atrial fibrillation on complications and mortality following Ivor Lewis esophagectomy for esophageal cancer. Scientific Reports, 15 (1). pp. 1-9. Springer Nature. ISSN 2045-2322

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Abstract

[Artikel-Nr.: 22305] Postoperative atrial fibrillation (POAF) is a common complication following transthoracic esophagectomy, with an incidence rate between 12% and 37%. POAF has been associated with adverse outcomes, including pulmonary complications, anastomotic leakage, prolonged ICU stays and increased in-hospital mortality. This study investigates the impact of POAF on postoperative outcomes in a high-volume center and evaluates its role as a predictor of postoperative complications following Ivor-Lewis esophagectomy.This retrospective, single-center cohort study was conducted at the University Hospital of Cologne, Germany. Patients, who underwent elective Ivor-Lewis esophagectomy for cancer, were included ( n = 617). Perioperative data were extracted retrospectively from a prospectively maintained database, capturing demographic, surgical, and postoperative variables. POAF was defined as a hemodynamically significant tachyarrhythmia absoluta that occurs within the first 7 days postoperatively and has been confirmed via ECG. Statistical analyses included univariate and multivariate logistic regression to identify associations between POAF and postoperative outcomes.POAF occurred in a significant proportion of patients ( n = 79, 12,8%) and was strongly associated with adverse outcomes. Patients with POAF demonstrated higher rates of pulmonary complications (24.0% vs. 11.2%, * p < .01), anastomotic leakage (32.9% vs. 10.5%, * p < .01), and prolonged ICU stays (median 7 days vs. 2 days, * p < .01). The in-hospital mortality rate in the POAF group was 7.6%, compared to 1% in patients without POAF (* p < .01). Independent predictors of POAF included older age, pre-existing atrial fibrillation and beta-blocker therapy. Postoperative atrial fibrillation (POAF) was a significant predictor of adverse postoperative outcomes. Logistic regression analysis revealed that POAF was associated with higher odds of anastomotic leakage (OR = 3.11, * p < .01), ICU readmission (OR = 6.80, * p < .01), in-hospital mortality (OR = 6.76, * p < .01) and 90-Day mortality ( OR = 5.44, * p < .01). In our cohort, POAF was not significantly associated with oncological recurrence (OR = 0.71; p = .219). These findings highlight the critical role of POAF in predicting postoperative complications.POAF is both - a complication and a potential marker - for systemic stress, predicting further adverse events such as anastomotic leakage and respiratory insufficiency. Although some studies suggest that POAF does not affect long-term survival, its pronounced impact on short-term morbidity underscores the necessity of early identification and focused management. Preoperative risk stratification and intraoperative strategies, such as goal-directed fluid therapy, could mitigate the impact of POAF. Postoperative atrial fibrillation (POAF) significantly influences recovery after esophagectomy, serving as a marker for increased morbidity and mortality. Advanced age, hypertension, and respiratory complications emerged as key independent risk factors. Additionally, POAF was linked to longer hospital stays, in-hospital and 90-day mortality and a heightened incidence of postoperative complications, including pneumonia and anastomotic leakage. These results highlight the critical importance of implementing targeted perioperative strategies to reduce risks and enhance outcomes in this high-risk patient population.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Torabi, Saeed UNSPECIFIED https://orcid.org/0000-0003-0646-0465 UNSPECIFIED Omuro, Philipp UNSPECIFIED https://orcid.org/0009-0000-4907-1852 UNSPECIFIED Dusse, Fabian UNSPECIFIED https://orcid.org/0000-0001-7762-6966 UNSPECIFIED Wirsik, Naita M. UNSPECIFIED https://orcid.org/0000-0003-1619-6354 UNSPECIFIED Schmidt, Thomas UNSPECIFIED https://orcid.org/0000-0002-7166-3675 UNSPECIFIED Schröder, Wolfgang UNSPECIFIED https://orcid.org/0000-0002-8700-069X UNSPECIFIED Kammerer, Tobias UNSPECIFIED https://orcid.org/0000-0001-8920-7187 UNSPECIFIED Steinbicker, Andrea U. UNSPECIFIED https://orcid.org/0000-0002-5237-961X UNSPECIFIED Schlößer, Hans A. UNSPECIFIED https://orcid.org/0000-0002-1304-7719 UNSPECIFIED Bruns, Christiane J. UNSPECIFIED https://orcid.org/0000-0001-6590-8181 UNSPECIFIED Fuchs, Hans F. UNSPECIFIED https://orcid.org/0000-0003-4764-8050 UNSPECIFIED Schiffmann, Lars M. UNSPECIFIED https://orcid.org/0000-0002-2320-5004 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-809577
Identification Number:	10.1038/s41598-025-06239-8
Journal or Publication Title:	Scientific Reports
Volume:	15
Number:	1
Page Range:	pp. 1-9
Number of Pages:	9
Date:	1 July 2025
Publisher:	Springer Nature
ISSN:	2045-2322
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Anästhesiologie und Operative Intensivmedizin > Klinik für Anästhesiologie und Operative Intensivmedizin
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Postoperative atrial fibrillation ; Ivor-Lewis esophagectomy ; Anastomotic leakage ; Pulmonary complications ; Postoperative morbidity English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80957