PREDICTORS OF MORTALITY AND POSTOPERATIVE ATRIAL FIBRILLATION AFTER NON-CARDIAC SURGERY
Objective. This paper specifically focuses on the study of determination of the predictors associated with the development of postoperative atrial fibrillation (POAF) and mortality rate after major abdominal non-cardiac surgical interventions. Methods. The methodology «Case-control study» has been used. The study included 226 patients: 83 - with a fatal outcome (cases) and 143 - without a fatal outcome (control group). Results. Independent predictors increasing risk of POAF developing were considered to be the followings: myocardial infarction in the anamnesis (MI) (OR 4.7, CI 2.2-10.1), cardiac arrhythmias (OR 5.0, CI 2.5-10.3), chronic kidney disease (CKD) (OR 8.7, CI 4.6-16.5), congestive heart failure (CHF) (OR 9.9, CI 5.2-19.1), diabetes (OR 4.0, CI 2-8), chronic obstructive pulmonary disease (COPD) (OR 8.6, CI 1.7-42.3), intraoperative infusion of more than 3 liters (OR 3.4, CI 1.6-7,4). Independent predictors increasing the risk of mortality rate were the followings: cardiac arrhythmias in the anamnesis (OR 3,4, CI 1.7-6,9), CKD (OR 248, CI 80-764), CHF 2-3 class (OR 6,8, CI 3,7-12,6), diabetes (OR 4.9, CI 2.3-9,6), COPD (OR CI 6,5, 1,3-32), intraoperative infusion of more than 3 liters (OR 2.9, CI 1.46-5.7), post-surgery fluid therapy of 3-5 liters (OR 2,9 1,6-5,0), POAF (OR 14,8, CI 7,4-29,4), thromboembolic complications (OR 37,9, CI 8,7-164). Age (>72 years) was statistically significant (p<0.001) was associated with POAF and with mortality rate. Conclusion. In abdominal non-cardiac surgical interventions. the development of POAF is a common complication of cardiac surgery. In patients with POAF, the risk of in-hospital mortality is significantly higher. Independent factors that increase the risk of mortality rate and POAF are largely similar and in this study were the followings: myocardial infarction in the anamnesis, heart rate variabily, chronic heart failure, chronic renal failure, diabetes, chronic obstructive pulmonary disease, as well as relaporotomy, inflammation and pneumonia. The quantitative component of the «extra volume» of infusion therapy associated with perioperative complications was also recorded.