66P - Effect of age on risk for atrial fibrillation following 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 Jessica Glover
Citation Annals of Oncology (2017) 28 (suppl_2): ii20-ii23. 10.1093/annonc/mdx085
Authors J. Glover1, S. Reynolds1, E. Ng1, M. Echavarria1, 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

Aging is a known risk factor for several post-operative comorbidities, including atrial fibrillation (AFib), leading to increased length of stay and mortality. This study was designed to investigate the effect of age and related comorbidities on new-onset atrial fibrillation after robotic-assisted pulmonary lobectomy to better identify patients at greatest risk.

Methods

We conducted a retrospective analysis of 353 consecutive patients without history of preoperative AFib who underwent robotic-assisted video-thoracoscopic (RAVTS) lobectomy by one surgeon from October 2010 to August 2016. Patients were analysed with respect to age and associated comorbidities, such as hypertension, hyperlipidaemia, and diabetes. Chi-Square (X2), Fisher’s exact test, and Student’s t-test were used to compare variables, with significance at p ≤ 0.05.

Results

The average age of participants who developed post-operative AFib (n = 33) was significantly higher, 72.8 years (yrs) vs. 66.4 yrs (p < 0.001). There was a decreased risk in patients under 70 yrs, with only 11 (5.3%) developing AFib (OR 0.31, CI 0.14-0.66, p = 0.002). By contrast, 22 (15.3%) of the elderly (age ≥70 yrs) experienced new-onset A-fib (OR 2.54, 95% CI 1.19 to 5.41, p = 0.02). Those under 60 yrs were at least risk (OR 0.10, 95% CI 0.01 to 0.75, p = 0.02), and those ≥80 yrs were at greatest risk (OR 2.74, 95% CI 1.03 to 7.28, p = 0.04). While the elderly in our cohort had a higher rate of many well-described comorbidities, including hypertension, hyperlipidaemia, coronary artery disease, and cardiomyopathy, none of these conferred an increased risk of post-operative AFib. Among those over 70 yrs, only BMI, particularly an obese BMI (≥30 kg/m2), led to a higher risk (p = 0.02 and p = 0.003, respectively). Among the elderly, obese patients developed AFib at 2.3 times the rate of those with normal or overweight BMI’s (OR 4.21, 95% CI 1.66 to 10.68, p = 0.002). Conversely, only being a former smoker increased the risk of AFib in those under 70 yrs (OR 4.79, 95% CI 1.23 to 18.70, p = 0.02). The risk in former smokers was independent of pack-years and duration of cessation prior to surgery. Furthermore, the risk of AFib was not significantly affected by intra-operative complications in either group.

Conclusions

Patients aged 70 years or older are at increased risk of AFib after RAVTS lobectomy, particularly if they are obese. Those under 70 years are at increased risk if they are former smokers.

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: Have received honoraria as robotic thoracic surgery observation site and proctor for Intuitive Surgical Corp. All other authors have declared no conflicts of interest.