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Evidence-based Practice and Quality Improvement

New onset atrial fibrillation during goitre surgery


Stojanovic, M.; Sabljak, V.; Markovic, D.; Ladjevic, N.; Zivaljevic, V.; Kalezic, N.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 28-28
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Background and Goal of Study: Atrial fibrillation (AF) is common complication during cardio-thoracic surgery with the reported incidence of up to 31.9%. AF occurs relatively rarely in non-cardiothoracic surgery. However, there is little data on the incidence of AF in euthyroid patients undergoing thyroid surgery. Therefore, the aim of our study was to determine the prevalence and risk factors for new onset atrial fibrillation (NOAF) in these patients.

Materials and Methods: We did a prospective study and included 1080 euthyroid goitre patients who were in sinus rhythm before operation. Patients with persistent AF were excluded. All surgery was performed during general anaesthesia. Intraoperatively, we noted the occurrence of NOAF. Patients were divided into two groups, the group with and the group without NOAF. We investigated the influence of the following characteristics on the occurrence of NOAF: age, sex, body mass index, ASA score, comorbidity, difficult intubation of trachea, type and duration of surgery and anaesthesia. We used t-test to compare the average values of the parametric features, while Pearson's chisquare test and was used to compare the differences in frequency of categorical feature. P values < 0.05 were considered statistically significant.

Results and Discussion: Our patients had following admission diagnosis: nodular goitre 359 (33.24%); multinodular goitre 652 (60.37%); recidivant goitre 69 (6.39%). NOAF was present in 7 patients (0.65%). Significantly more patients from the NOAF group had preoperatively coronary artery disease (28.57% vs. 5.13%, p = 0.019) and some kind of heart rhythm disturbance in contrast to patients without registered NOAF (42.86% vs. 7.45%, p = 0.001). Two patients had earlier AF from the group of patients with NOAF and 34 from the group without NOAF (66.67% vs. 37.78%), while VES/SVES was present in one patient (33.3%) from the NOAF group and 21 patients (23.33%) from the group without NOAF. The reported incidence of AF during non-cardiothoracic surgery ranges from 0.37% to 20%, dependent of the type of surgery.Our result, 0.65% incidence of NOAF during thyroid surgery is similar to other type of intermediate-risk surgery.

Conclusion(s): We found correlation between earlier occurrence of AF and coronary artery disease with NOAF during thyroid surgery.

© 2013 European Society of Anaesthesiology