Certain surgical techniques appear to increase the risk for patients to experience atrial fibrillation, a common rhythm disturbance, after coronary artery bypass graft surgery -- CABG -- according to a new study conducted at Yale and 23 other university- affiliated medical centers across the United States. The researchers also recommend that patients spend several extra days in the hospital to treat the rhythm disturbance.
In a study of 2,417 patients undergoing CABG surgery, an average of 27 percent of them experience this common heart rhythm disorder. The condition is more likely to occur in older male patients with a history of heart failure, according to Dr. Joseph P. Mathew, assistant professor of anesthesiology at the School of Medicine and the study's first author.
Dr. Mathew and his colleagues reported the findings in the July 24 issue of the Journal of the American Medical Association. He conducted the study in association with the Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation, based in San Francisco.
"Patients who develop atrial fibrillation after CABG surgery spend an average of 13 extra hours in the intensive care unit and two extra days in the hospital," Dr. Mathew says. "The extra time is usually needed to control the fast heart rate, to treat patients with blood-thinning medication, or to treat the complications associated with this condition."
The current study indicates that the occurrence of atrial fibrillation after surgery was strongly associated with neurological injury, he adds.
Using approximate estimates of cost, the occurrence of atrial fibrillation after this type of surgery increases the overall cost of surgery by at least $1,616, the researchers found. In the United States, where 350,000 CABG surgeries are performed each year, the additional costs of the prolonged hospitalization, excluding treatment costs, is $153 million per year.
"In an effort to decrease costs, people who have had CABG surgery often are discharged from the hospital as early as three to five days after their surgery, which is just about the same time that this common rhythm disturbance shows up," the anesthesiologist points out. "The occurrence of atrial fibrillation will limit these cost- containment efforts.
"In this era of decreasing reimbursement for medical costs, it is important that this heart rhythm disturbance be identified and the patients treated before they go home," Dr. Mathew says.