Supraventricular arrhythmia in patients having noncardiac surgery: Clinical correlates and effect on length of stay

Background: Few recent data are available on risk factors for perioperative supraventricular arrhythmia (SVA) after noncardiac surgery or on the effect of SVA on clinical outcomes. Objective: To determine the incidence, clinical correlates, and effect on length of stay of perioperative SVA in patients having major noncardiac surgery. Design: Prospective cohort study. Setting: Urban tertiary care teaching hospital. Participants: 4181 patients 50 years of age or older who had major, nonemergency, noncardiac procedures and were in sinus rhythm at the preoperative evaluation. Measurements: Preoperative clinical data, postoperative enzyme data, serial electrocardiograms, and clinical outcomes were collected prospectively. Outcomes were 1) SVA that persisted or led to treatment and 2) increase in length of stay attributable to SVA. Results: Perioperative SVA occurred in 317 patients (7.6%); it occurred in 83 patients (2.0%) during surgery and in 256 (6.1 %) after surgery. Independent preoperative correlates of SVA were male sex (odds ratio [OR], 1.3 [95% CI, 1.0 to 1.7]), age 70 years or older (OR, 1.3 [CI, 1.0 to 1.7]), significant valvular disease (OR, 2.1 [CI, 1.2 to 3.6]), history of SVA (OR, 3.4 [CI, 2.4 to 4.8]) or asthma (OR, 2.0 [CI, 1.3 to 3.1]), congestive heart failure (OR, 1.7 [CI, 1.1 to 2.7]), premature atrial complexes on preoperative electrocardiography (OR, 2.1 [CI, 1.3 to 3.4]), American Society of Anesthesiologists class III or IV (OR, 1.4 [CI, 1.1 to 1.9]), and type of procedure: abdominal aortic aneurysm (OR, 3.9 [CI, 2.4 to 6.3]) or abdominal (OR, 2.5 [CI, 1.7 to 3.6]), vascular (OR, 1.6 [CI, 1.1 to 2.4]), and intrathoracic (OR, 9.2 [CI, 6.7 to 13]) procedures. Among patients who had intrathoracic surgery, those receiving digoxin were at lower risk (OR, 0.2 [CI, 0.04 to 0.8]) for SVA than those not receiving digoxin. Patients with perioperative acute cardiac and noncardiac events had high relative risks for SVA. Supraventricular arrhythmia was associated with a 33% increase in length of stay after adjustment for other clinical data (P < 0.001). Conclusions: In this cohort, SVA was common after noncardiac surgery and was associated with prolonged length of stay.