Our Summary

This research article is about a common complication that can occur after chest surgery that is not related to the heart, known as perioperative atrial fibrillation and flutter (POAF). This condition can cause instability in the circulation of the blood, longer hospital stays, a higher chance of stroke, and an increased risk of death. The exact causes of POAF after such surgeries are not entirely known, as they can be influenced by many factors. Identifying the risk factors and predicting the likelihood of POAF can help in preventing and managing this condition in patients who undergo these types of surgery. In this paper, the authors have looked at related studies to come up with a practical strategy that can be used by anesthesiologists to better predict, prevent, and manage POAF in patients going through non-heart related chest surgeries.

FAQs

  1. What is perioperative atrial fibrillation and flutter (POAF) and how common is it in non-cardiac thoracic surgery?
  2. What are the risks associated with POAF after non-cardiac thoracic surgery?
  3. What strategies are available to predict, prevent, and manage POAF in patients undergoing non-cardiac thoracic surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about thoracic surgery is to reduce their risk of developing perioperative atrial fibrillation and flutter (POAF) by following a healthy lifestyle, including maintaining a healthy weight, exercising regularly, managing stress, and quitting smoking if applicable. Additionally, discussing any pre-existing medical conditions or medications with your healthcare team before surgery can help reduce the risk of complications. Finally, following post-operative care instructions and attending follow-up appointments is crucial for monitoring and managing any potential complications.

Suitable For

Patients who are typically recommended for thoracic surgery include those with lung cancer, esophageal cancer, mediastinal tumors, benign lung nodules, and certain types of chest wall deformities or abnormalities. Additionally, patients with severe respiratory conditions such as emphysema or chronic obstructive pulmonary disease (COPD) may also be candidates for thoracic surgery. Other conditions that may warrant thoracic surgery include esophageal motility disorders, advanced stage lung infections, and certain types of congenital heart defects. It is important for patients to undergo a thorough evaluation by a multidisciplinary team of healthcare providers to determine if thoracic surgery is the appropriate treatment option for their specific condition.

Timeline

Before thoracic surgery:

  1. Pre-operative evaluation: The patient will undergo a thorough medical history review, physical examination, and possibly additional tests such as blood work, imaging studies, and pulmonary function tests to assess their overall health and suitability for surgery.
  2. Informed consent: The patient will meet with their healthcare team to discuss the risks and benefits of the surgery, as well as alternative treatment options. They will then provide informed consent for the procedure.
  3. Pre-operative preparation: The patient may be instructed to stop taking certain medications, refrain from eating or drinking for a period of time before surgery, and follow specific pre-operative instructions provided by their healthcare team.

After thoracic surgery:

  1. Immediate post-operative period: The patient will be closely monitored in the recovery room for any signs of complications such as bleeding, infection, or respiratory distress. Pain management and respiratory therapy may be initiated.
  2. Hospital stay: The patient will be transferred to a hospital room where they will continue to be monitored for any post-operative complications. Physical therapy and breathing exercises may be initiated to aid in recovery.
  3. Follow-up care: The patient will have follow-up appointments with their healthcare team to monitor their recovery progress, manage any ongoing symptoms or complications, and discuss long-term care and rehabilitation options.
  4. Rehabilitation: Depending on the extent of the surgery and the patient’s overall health, they may undergo a period of rehabilitation to regain strength, mobility, and function after surgery. This may include physical therapy, occupational therapy, and other interventions to support recovery.

What to Ask Your Doctor

  1. What are the specific risks and potential complications associated with thoracic surgery?

  2. How can I minimize my risk of developing atrial fibrillation or flutter after surgery?

  3. Are there any pre-existing medical conditions or medications that may increase my risk of developing atrial fibrillation or flutter after surgery?

  4. What steps will be taken during the surgery to monitor and prevent atrial fibrillation or flutter?

  5. How will atrial fibrillation or flutter be diagnosed and managed if it occurs after surgery?

  6. What is the typical recovery process for patients who develop atrial fibrillation or flutter after thoracic surgery?

  7. Are there any lifestyle changes or medications that may help reduce the risk of developing atrial fibrillation or flutter in the future?

  8. How frequently will follow-up appointments be needed to monitor for any potential complications, including atrial fibrillation or flutter?

  9. Are there any specific warning signs or symptoms that I should watch for after surgery that may indicate the development of atrial fibrillation or flutter?

  10. Are there any additional resources or support services available to help me better understand and manage the potential risks associated with thoracic surgery?

Reference

Authors: Liu J, Huang Y, Ma W, Liu H, Cao Y, Wu C. Journal: Minerva Anestesiol. 2022 Jun;88(6):490-498. doi: 10.23736/S0375-9393.21.16034-1. Epub 2022 Apr 26. PMID: 35475332