Diabetes Predisposes Patients To Atrial Fibrillation After Robotic-assisted Video-thoracoscopic Pulmonary Lobectomy
Samuel B. Reynolds1, Jessica R. Glover1, Maria F. Echavarria1, Emily P. Ng1, Frank O. Velez-Cubian1, Carla C. Moodie2, Joseph R. Garrett2, Jacques P. Fontaine2, Eric M. Toloza2.
1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA.
OBJECTIVE: This study sought to determine whether pre-existing diabetes in patients undergoing robotic-assisted pulmonary lobectomy is a risk factor for development of atrial fibrillation (AFib) in the early post-operative period and whether associated comorbidities worsen prognosis.
METHODS: Excluding patients with preoperative history of AFib, 353 consecutive patients who underwent robotic-assisted video thoracoscopic (RAVTS) lobectomy by one surgeon from September 2010 through August 2016 were retrospectively analyzed. Patients were studied with respect to 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). Mean 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), hyperlipidemia (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 associated 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 (FEV1%) between diabetics who did and who 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, hyperlipidemia, and kidney disease, did not confer an increased risk for development of AFib after surgery. However, being a former smoker puts diabetics at 10-times greater risk than current or never smokers with diabetes.
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