63P - Diabetes predisposes patients to atrial fibrillation after robotic-assisted video-thoracoscopic pulmonary lobectomy

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Lung and other Thoracic Tumours
Surgery and/or Radiotherapy of Cancer
Presenter Samuel Reynolds
Citation Annals of Oncology (2017) 28 (suppl_2): ii20-ii23. 10.1093/annonc/mdx085
Authors S. Reynolds1, J. Glover1, M. Echavarria1, E. Ng1, F. Velez-Cubian2, C. Moodie3, J. Garrett3, J. Fontaine3, E. Toloza3
  • 1University of South Florida Health Morsani College of Medicine, 33612 - Tampa/US
  • 2Department Of Surgery, University of South Florida Health Morsani College of Medicine, 33612 - Tampa/US
  • 3Thoracic Oncology, Moffitt Cancer Center, 33612 - Tampa/US

Abstract

Background

Pre-existing diabetes has been described as a risk factor for the development of atrial fibrillation (AFib) following non-cardiac surgery. This study aimed to determine if diabetes and associated comorbidities increase the risk of AFib following robotic-assisted pulmonary lobectomy and improve risk stratification of diabetics.

Methods

Excluding patients with preoperative history of AFib, 353 consecutive patients who underwent robotic-assisted video thoracoscopic (RAVTS) lobectomy by one surgeon from October 2010 to August 2016 were retrospectively analysed. Patients were studied with respect to the presence of diabetes, coronary artery disease, heart failure, kidney failure, peripheral vascular disease, and other known associated comorbidities. Chi-Square (X2), Fisher’s exact test, and Student’s t-test were used to compare variables, with significance at p ≤ 0.05.

Results

In this study, 64 patients with diabetes were identified, 11 (17.2%) of whom developed AFib following RAVTS lobectomy. Patients with diabetes were at higher risk of developing of AFib following surgery (OR 2.52, 95% CI 1.15 to 5.50, p = 0.02). The average age of diabetics who developed AFib was 72.7 years and 68.4 years for those who did not (p = 0.07). Known comorbidities in patients with diabetes did not confer additional risk, including hypertension (p = 1.00), hyperlipidaemia (p = 1.00), cardiomyopathy (p = 0.17), coronary artery disease (p = 0.27), and obesity (p = 0.67). There was a trend toward increased risk in diabetics with kidney disease, although it failed to reach significance (p = 0.07). Being a former smoker was the only independent risk factor identified, as 90.9% of diabetics with AFib were former smokers (OR 10.38, 95% CI 1.24 to 86.95, p = 0.03). Pack-years did not increase risk for AFib, with 47.2 pack-years on average being reported in those who developed AFib, while patients without AFib averaged 49.6 pack-years (p = 0.87). Furthermore, there was no significant difference in pre-operative percent forced expiratory volume in 1 second of diabetics who did and did not develop AFib (87.0% vs 80.4%, p = 0.45).

Conclusions

Patients with diabetes are at higher risk for developing AFib after RAVTS lobectomy. Known comorbidities of diabetes, including obesity, hyperlipidaemia, and kidney disease, did not confer an increased risk for the development of AFib after surgery; however, being a former smoker puts diabetics at 10-times greater risk than current or never smokers with diabetes.

Clinical trial identification

Not applicable.

Legal entity responsible for the study

Eric M. Toloza, M.D., Ph.D.

Funding

Moffitt Cancer Center and University of South Florida Health Morsani College of Medicine

Disclosure

J. Fontaine, E. Toloza: Honoraria as robotic thoracic surgery observation site and proctor for Intuitive Surgical Corp. All other authors have declared no conflicts of interest.