Smoking history as a risk factor for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy

Abstract

Background: Smoking history has been correlated to the development of atrial fibrillation (AFib) after noncardiac thoracic surgery, increasing hospital length of stay, postoperative mortality, and costs. This study sought to determine the effects of smoking history and pulmonary function on the development of AFib following robotic-assisted pulmonary lobectomy to allow for more targeted dispositioning of post-lobectomy patients. Method(s): We retrospectively analysed 353 consecutive patients without history of AFib who underwent robotic-assisted video thoracoscopic (RAVTS) lobectomy by one surgeon from October 2010 to August 2016. Patients were analysed with respect to smoking status, pack-years, months of smoking cessation, and pulmonary function. Chi-Square (X2), Fisher's exact test, and Student's t-test were used to compare variables with significance at p<0.05. Result(s): In our study, 17 of 144 men (11.8%) and 16 of 209 women (7.7%) experienced new-onset AFib following RAVTS lobectomy (p=0.19). The average age of people who developed AFib was 72.8 years (yrs) and 66.4 yrs for those who did not (p<0.001). Former smokers represented 72.7% of new AFib cases, current smokers 21.2%, and never smokers 6.1% (p=0.009). Former smokers were at higher risk than both never (OR 5.30, 95% CI 1.22 to 23.09, p=0.03) and current smokers (OR 2.62 95% CI 1.09 to 6.31, p=0.03). Former smokers who developed AFib also were older (74.6 vs. 69.1 yrs, p=0.004) and more often diabetic (OR 3.27, 95% CI 1.31 to 8.17 p=0.01). There was no difference in AFib rates for light ( 15 pack-years) smokers (p=0.21). Never smokers fared better than light (p=0.02) but not heavy (p=0.13) smokers. There was no difference in pack-years for former and current smokers who developed AFib (p=0.11). For all groups, the development of AFib was independent of pre-operative pulmonary function as measured by percent of predicted forced expiratory volume in 1 second and percent of predicted diffusion capacity of the lung for carbon monoxide (p=0.09 and 0.63, respectively). The development of AFib was also unaffected by the presence of COPD (p=0.80). Conclusion(s): Former and light smokers are at higher risk than both current and never smokers for developing AFib after RAVTS lobectomy, independent of pack-years and pre-operative pulmonary function. Duration of smoking cessation prior to lobectomy does not change the likelihood of developing AFib.