Abstract 18447: Peri-operative Atrial Fibrillation (POAF) Complicating Non-cardiothoracic Surgery: A Systematic Review
Bibliographic record
Abstract
Introduction: More than 37 million non cardiothoracic operations are performed in the USA per annum. Single studies have reported that peri-operative atrial fibrillation (POAF) complicates non-cardiac surgery in ≤12% of patients. It is not clear if POAF is associated with adverse outcomes. Purpose: We conducted a systematic review to determine the frequency and implications of POAF. Methods: We conducted a literature search of MEDLINE, Embase, HTA, Cochrane, and Pubmed databases. We defined POAF as a single episode of AF confirmed by ECG within 30 days of non cardiothoracic surgery. Inclusion criteria were published manuscripts and abstracts containing patient level information. We excluded studies which were not published in English, described cardiothoracic surgery, were missing patient-level AF data or included patients aged <18 years. Results: Our search produced 4445 publications, from which 716 abstracts and 534 manuscripts were identified for review. After applying inclusion/exclusion criteria, 225 manuscripts were analysed. Combining all studies, POAF occurred in 18789/650120 patients (2.9%, n=172, median [IQR] 2.2% [0.9-5.8]). Among 37 prospective studies, POAF occurred in 517/10990 patients (4.7%, n=37, 3.23% [1.0-8.8]). AF was prospectively identified pre-op in 875/26596 (3.3%, n=18, 9.0% [5.5-13.1]) and post-op in 472/14719 (3.2%, n=18, 8.8% [5.5-13.0]). In 135 retrospective studies, POAF occurred in 18272/639130 patients (2.9% n=135, 2.13 [0.8-4.4]). In retrospective analyses, AF was pre-existent in 49756/2440489, (2.0%, n=44, 6.7% [4.3-13.1]) and de novo in 12043/1641875, (0.7%, n=23, 6.0% [1.6-12.3]). Stratifying by surgery type, POAF was most common in vascular (104/1380, 7.5%), followed by orthopaedic (128/2384, 5.4%), and neurosurgical (197/4390, 4.5%) patients. Patient outcomes were not systematically reported: at 1 year, mortality occurred in 927/4136 (22.4%) POAF patients, compared to 8498/63746 (13.3%) non-POAF patients (n=7). Conclusions: POAF occurred in 2.9% of 650120 patients and was associated with a 68% increase in mortality. Prospective research is required to determine whether any specific intervention(s) in POAF patients will improve outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.036 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.005 |
| Bibliometrics | 0.013 | 0.017 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".