Importance Outcomes of postoperative atrial fibrillation (AF) after noncardiac surgery are not well defined. Objective To determine the association of new-onset postoperative AF vs no AF after noncardiac surgery with risk of nonfatal and fatal outcomes. Design, Setting, and Participants Retrospective cohort study in Olmsted County, Minnesota, involving 550 patients who had their first-ever documented AF within 30 days after undergoing a noncardiac surgery (postoperative AF) between 2000 and 2013. Of these patients, 452 were matched 1:1 on age, sex, year of surgery, and type of surgery to patients with noncardiac surgery who were not diagnosed with AF within 30 days following the surgery (no AF). The last date of follow-up was December 31, 2018. Exposures Postoperative AF vs no AF after noncardiac surgery. Main Outcomes and Measures The primary outcome was ischemic stroke or transient ischemic attack (TIA). Secondary outcomes included subsequent documented AF, all-cause mortality, and cardiovascular mortality. Results The median age of the 452 matched patients was 75 years (IQR, 67-82 years) and 51.8% of patients were men. Patients with postoperative AF had significantly higher CHA2DS2-VASc scores than those in the no AF group (median, 4 [IQR, 2-5] vs 3 [IQR, 2-5]; P < .001). Over a median follow-up of 5.4 years (IQR, 1.4-9.2 years), there were 71 ischemic strokes or TIAs, 266 subsequent documented AF episodes, and 571 deaths, of which 172 were cardiovascular related. Patients with postoperative AF exhibited a statistically significantly higher risk of ischemic stroke or TIA (incidence rate, 18.9 vs 10.0 per 1000 person-years; absolute risk difference [RD] at 5 years, 4.7%; 95% CI, 1.0%-8.4%; HR, 2.69; 95% CI, 1.35-5.37) compared with those with no AF. Patients with postoperative AF had statistically significantly higher risks of subsequent documented AF (incidence rate 136.4 vs 21.6 per 1000 person-years; absolute RD at 5 years, 39.3%; 95% CI, 33.6%-45.0%; HR, 7.94; 95% CI, 4.85-12.98), and all-cause death (incidence rate, 133.2 vs 86.8 per 1000 person-years; absolute RD at 5 years, 9.4%; 95% CI, 4.9%-13.7%; HR, 1.66; 95% CI, 1.32-2.09). No significant difference in the risk of cardiovascular death was observed for patients with and without postoperative AF (incidence rate, 42.5 vs 25.0 per 1000 person-years; absolute RD at 5 years, 6.2%; 95% CI, 2.2%-10.4%; HR, 1.51; 95% CI, 0.97-2.34). Conclusions and Relevance Among patients undergoing noncardiac surgery, new-onset postoperative AF compared with no AF was associated with a significant increased risk of stroke or TIA. However, the implications of these findings for the management of postoperative AF, such as the need for anticoagulation therapy, require investigation in randomized trials.

中文翻译：

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非心脏手术后新发房颤与随后的中风和短暂性脑缺血发作的关联

非心脏手术后房颤 (AF) 的重要性尚未明确定义。目的 确定非心脏手术后新发术后 AF 与无 AF 与非致命性和致命性结局风险的关联。设计、设置和参与者 在明尼苏达州奥姆斯特德县进行的回顾性队列研究，涉及 550 名患者，这些患者在 2000 年至 2013 年期间接受非心脏手术（术后房颤）后 30 天内首次出现房颤。在这些患者中，有 452 名匹配非心脏手术患者在手术后 30 天内未诊断为 AF（无 AF）的年龄、性别、手术年份和手术类型为 1:1。随访的最后日期为 2018 年 12 月 31 日。 术后 AF 与非心脏手术后无 AF 的暴露。主要结果和措施 主要结果是缺血性卒中或短暂性脑缺血发作 (TIA)。次要结果包括随后记录的 AF、全因死亡率和心血管死亡率。结果 452 名匹配患者的中位年龄为 75 岁（IQR，67-82 岁），51.8% 的患者为男性。术后房颤患者的 CHA2DS2-VASc 评分显着高于非房颤组（中位数，4 [IQR，2-5] vs 3 [IQR，2-5]；P < .001）。在中位随访 5.4 年（IQR，1.4-9.2 年）中，有 71 例缺血性卒中或 TIA、266 例随后记录的 AF 发作和 571 例死亡，其中 172 例与心血管相关。术后房颤患者出现缺血性卒中或 TIA 的风险在统计学上显着升高（发生率，18.9 vs 10.0/1000 人年；5 年时的绝对风险差 [RD]，4.7%；95% 置信区间，1.0%-8.4%；人力资源，2.69；95% CI, 1.35-5.37) 与那些没有 AF 的人相比。术后 AF 患者随后记录 AF 的风险在统计学上显着更高（发生率 136.4 vs 21.6/1000 人年；5 年时的绝对 RD，39.3%；95% CI，33.6%-45.0%；HR，7.94；95% CI，4.85-12.98）和全因死亡（发生率，133.2 vs 86.8/1000 人年；5 年时的绝对 RD，9.4%；95% CI，4.9%-13.7%；HR，1.66；95% CI，1.32-2.09）。术后 AF 和无术后 AF 患者心血管死亡风险无显着差异（发生率，42.5 vs 25.0/1000 人年；5 年绝对 RD，6.2%；95% CI，2.2%-10.4%； HR，1.51；95% CI，0.97-2.34）。结论和相关性 在接受非心脏手术的患者中，与无 AF 相比，术后新发 AF 与卒中或 TIA 风险显着增加相关。然而，这些发现对术后房颤管理的影响，例如抗凝治疗的需要，需要在随机试验中进行调查。