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• W2013903956 abstract "You have accessJournal of UrologyBladder Cancer: Natural History and Pathophysiology1 Apr 2015MP64-12 POSTOPERATIVE ATRIAL FIBRILLATION FOLLOWING RADICAL CYSTECTOMY PREDICTS FUTURE CARDIOVASCULAR EVENTS Robert Blackwell, Chandy Ellimoottil, Petar Bajic, Matthew Zapf, Anai Kothari, Paul Kuo, Robert Flanigan, Marcus Quek, and Gopal Gupta Robert BlackwellRobert Blackwell More articles by this author , Chandy EllimoottilChandy Ellimoottil More articles by this author , Petar BajicPetar Bajic More articles by this author , Matthew ZapfMatthew Zapf More articles by this author , Anai KothariAnai Kothari More articles by this author , Paul KuoPaul Kuo More articles by this author , Robert FlaniganRobert Flanigan More articles by this author , Marcus QuekMarcus Quek More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2323AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-operative atrial fibrillation (POAF) following radical cystectomy is reported to occur in 2-8% of cases. Recent evidence suggests that even transient POAF predicts future cardiovascular (CV) events. The effects of POAF in the radical cystectomy population are largely unknown. METHODS We used the Healthcare Cost and Utilization Project State Inpatient Database for Florida (2009-2011) to identify patients who underwent radical cystectomy (ICD-9 57.71) and had atrial fibrillation listed as a diagnosis (ICD-9 427.3). We excluded patients with a preexisting diagnosis of atrial fibrillation. Medical comorbidities were identified to compute a CHA2DS2-VASc score (a validated risk score for atrial fibrillation) for each patient. Inpatient admissions were linked across years to provide long-term follow-up. The primary endpoint was a composite of CV events, including myocardial infarction, pulmonary embolism, stroke, cardiac arrest, or death. CV events were excluded if they occurred during the surgical admission or after 6 months postoperatively. We fit a multivariable mixed-effects logistic regression model to assess the effect of POAF on CV events after adjusting for CHA2DS2-VASc score. RESULTS Radical cystectomy was performed in 2,086 patients, of whom 160 had preexisting atrial fibrillation and were excluded. Of the remaining 1,926 patients, 105 (5.5%) developed POAF. POAF patients had a higher mean CHA2DS2-VASc score (2.9 vs 2.2, p<0.001), were older, and more likely to have a diagnosis of hypertension (all p<0.05). CV events were noted in 69 patients (3.6%) during the initial 6-month postoperative period, and occurred more often in those with POAF (10.5 vs 3.2%, χ2=15, p<0.001). Univariate analysis also indicated age >75 years, hypertension, and congestive heart failure all increased the risk for CV event, while age <65 years decreased the risk (all p<0.05). Our multivariable logistic regression model (Table) revealed that POAF was associated with increased risk of a CV event within the first 6 months after surgery (OR 2.8, p=0.004). CONCLUSIONS The presence of POAF is independently associated with an increased risk of adverse CV events in the postoperative period. These findings suggest that patients who develop even transient POAF should be monitored closely for at least six months after surgery. Multivariate Analysis Variable OR (95% CI) p value Postoperative Atrial Fibrillation 2.8 (1.4 - 5.5) 0.004 Age < 65 years 0.4 (0.2 - 0.8) 0.008 Age 65 - 75 years 0.6 (0.3 - 1.0) 0.045 Age > 75 years omitted Gender 1.0 (0.6 - 1.8) 0.9 Hypertension 1.6 (0.9 - 2.8) 0.1 Diabetes Mellitus 0.9 (0.5 - 1.5) 0.6 Congestive Heart Failure 2.2 (0.9 - 5.5) 0.09 Peripheral Vascular Disease 1.2 (0.5 - 3.0) 0.7 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e802 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Robert Blackwell More articles by this author Chandy Ellimoottil More articles by this author Petar Bajic More articles by this author Matthew Zapf More articles by this author Anai Kothari More articles by this author Paul Kuo More articles by this author Robert Flanigan More articles by this author Marcus Quek More articles by this author Gopal Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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