Complications of Operations with AFIB

[TikaTora]

Just read a report stating Patients with preexisting atrial fibrillation (AF) have a 31% increased risk of death within 30 days after noncardiac surgery compared with matched patients without AF. I guess my hip operation being cancelled would have been easier to accept if this had been explained

[Desanthony]

Where did you read this? Be interesting to read the source and any other interesting bits of info from the same source. When I had my hip replacement back in 2010 I was interested that the info from the hospital said that 1 in 500 die with this op. Having read this I thought a lot of people having a hip replacement are a great deal older than I am and have far more co-morbidities. So wasn't worried. I didn't even bother reading that info when I had my total knee replacement in 2019 - I just thought I had died and occasionally when in pain doing my exercises wish I had. I am pleased to say it was all worth it though.

[Teresa156]

Hi TikaTora,

Thanks for posting about this, however one statement stuck out to me “Patients with AF had more comorbidities, which may at least partially account for the increased risk”.

It doesn’t say what those were, or how bad they were. I doubt the organisers of the study even knew. They could have had anything going on, but seem to have highlighted the AF factor instead. AF itself is not a killer we are always told, but it’s the company it keeps.

Not everyone with afib has comorbidities and even if they do, some can be mild.

I think there are limitations and caveats to this study, regardless of how many were included.

[mav7 in reply to Teresa156]

“Patients with AF had more comorbidities, which may at least partially account for the increased risk”.

@TikaTora As quoted by Teresa, the above statement is key.

The Cleveland Clinic is one of the most respected medical institutions in the US. A leader in research. I am disappointed that this incomplete study was published without more definitive information like exact patient comorbidities and specify the type of surgery. Seems very likely the surgery was more detailed than a hip replacement, knee surgery, colonoscopy, etc.

That said, a patient needs to discuss with the surgeon prior about their afib status and insure coordination has been made with the cardiologist/EP.

Thanks for posting, Tika. Though the study has questions very informative.

[Poochmom in reply to mav7]

My guess and I could be wrong is it has something to do with the stroke risk of AFib.

[Autumn_Leaves]

31% increased risk doesn’t mean 31% of the people, or that you have a 31% chance of dying. Assuming Desanthony’s figure is still current, the increased risk is 31% x 1/500 (ie from the baseline risk). So that means 1.31/500.

[Singwell in reply to Autumn_Leaves]

Glad you explained this as the 31% could be confusing. Not 31% chance of death for each person.

[frazeej in reply to Autumn_Leaves]

Wow! That explanation is certainly better than just 31%!!!! WHEW!!

[Autumn_Leaves in reply to frazeej]

Many people don’t understand the concept of “relative risk” ie a statistical risk over and above the pre existing baseline risk. It’s also a common misconception that the default position is zero risk whereas none of us has a zero risk for anything. If the baseline risk is very small, a statistically increased risk is still going to be very small. It still doesn’t mean something is bound to happen.

Headline writers use these figures to over-dramatise for the purpose of attracting readers but these writers are not science or health communicators, and they use emotion to draw people in. It all contributes to the prevalence of health misinformation. This particular article is very thorough, cites good quality studies and explains the increase in risk and puts forward possible explanations eg more comorbidities, temporarily stopping anticoagulants. The first line is what grabs people though, and all the detail and nuance is disregarded or not fully understood and hence “OMG! People with AF are doomed! I’m never having any surgery for anything ever again!” And then it’s “OMG! Me neither!” It’s actually not easy to acquire the skills of health/media/science literacy so I don’t blame people for getting scared, but it’s far better to gain those skills for the sake of your own decision making.

[JaneFinn]

I didn’t know that statistic, but my gallbladder consultant said something very similar, and said he wasn’t prepared to do surgery to remove my gallbladder, unless i had to go in as an emergency admission and there was no choice. He wants me first to have an ablation to ‘fix’ my AF, and have been off my anticoagulants for a few months, in order to reduce the risks back down to ‘normal’ level surgery risk. I thought he was just being alarmist, but I’m wondering now!

[Hylda2 in reply to JaneFinn]

Odd isn’t it. I was having an AF episode when I went for pre-op check up for minor surgery. That was the end of that!!

[Desanthony]

Interested about the gall bladder op. I have known four people 3 of them I worked with and the other was a relative with gall bladder problems - none of them had AF. all were young - under or around 40 -no co-morbidities. Two of them were immediately put on the list for the op whereas the others were told they had to wait until it was an emergency. One of them decided she had had enough and had the operation done privately. I think the other lady I worked with went to A&E next time she had an episode and got herself on the list that way. At the time we put it down to them being at different D's surgeries as the two who were told they had to wait until it was an emergency were with one surgery and the other two with another.

[Jalia]

News to me ! I had total hip replacement early last year 6 months after my 4th ablation. Age then 77. Anaesthetist did require me to hsve a check up and echo with cardiologist before he would proceed. Instructions given to anaesthetist on procedure to follow should I flip into AF during the op. All went well.

[Autumn_Leaves in reply to Jalia]

That’s the important point. It’s not just having AF or not having AF, but the overall health of the individual. Two people with AF could have very different echocardiogram results, different degrees of severity, medication, etc, plus there are all the other factors to take into account, even including support at home and ability to take part in post op/rehab activities. All these things determine the outcome of the op.

[healingharpist in reply to Autumn_Leaves]

Autumn, THANK YOU SO MUCH for your insightful and much-needed comments on that article. Every time someone quotes a study w/ a scary title, I feel frustration at all that ISN'T said. Another factor no one understands is etiology--that the underlying or proximal CAUSE of AF episodes can be so entirely different from one patient to the next, thus actual individual risk (of death, cardiac events, etc.) cannot be known just because we all happen to have AF episodes. I'm a research dr & and the whole relative risk subject... it's a big blank to most people. That really should be discussed by cardiologists with their patients, but it doesn't happen. Please keep putting your oar in, it's very helpful!! (and calms me down, ha ha :-)) Best of health, Diane

[Autumn_Leaves in reply to healingharpist]

Thank you very much. I am humbled! ❤️

[kocoach]

They might have meant to say that most people with afib are on an anticoagulant which prevents clotting which is necessary for an incision wound to heal or a vein or whatever they are repairing but if they stop taking it prior to operation and goes into afib it could cause blood clots, it's a two edged sword. I had an operation a few years back and on the operating table went into afib and the Dr. said they had to wait a couple of hours before resuming procedure but everything turned out satisfactorily thank GOD.

[Thomas45]

I've had one emergency operation while in permanent, though asymptomatic, AF. A out five years ago, I had a grumbling pain below my left ribs and saw an out of hours go at 11am on a Saturday morning. He said he thought he knew what it was and told me to drive home, get what I needed for a short hospital stay, and then get a taxi to a stated hospital, and to go to a particular ward, where they would be expecting me.It was 2.30pm when I arrived at the ward, and while everyone else was being given cups of tea, the sign by my bed said Nil by mouth.

My INR was 2.6, so I had vitamin k intravenously, and antibiotics the same way. At 11pm an anesthesiologist told me the operation would be "in the morning", and so it was, at 2.30am on the Sunday. They said if anything untoward happened they'd keep me under anesthesia until it was sorted, and so it was, 3 hours after the operation had finished, that they woke me up. Attached to me was a heart rate monitor showing my rate at 190bpm.

I was in hospital for 2.5 days longer than planned while my heart rate slowly dropped to about 75bpm.

[HGates in reply to Thomas45]

What did the grumbling pain below your left rib turn out to be??

[Thomas45 in reply to HGates]

Oops, forgot to mention it, a grumbling appendix which was removed.

[BenHall1]

Hi,

I had a knee replacement op in Nov. 2015 ( aged 71), and at that time was in and out of AF fairly regularly. Had a full and frank discussion with both surgeon and anesthetist and neither were particularly phased. I was ( and still am ) on Warfarin and all I did was stop taking it for 6 days prior to surgery. Then, when I was wheeled back to my room, I was given a double injection of Fragmin ( a bridging anticoagulant) and that evening restarted my Warfarin. Absolutely no problems. Never heard of those fact sheet figures you quote. Never told about them either.

Dealing with pain after knee replacement was a significantly different proposition, the exercises felt like torture.

[Ppiman]

Statistics are a vital aspect of medicine - but only if used well. Sadly, even in published studies, they can be used without thought and, sometimes, even intentionally abused; and, of course, they are very easily misunderstood. Even the people who should know better can be guilty. I once complained about alarmist statistics regarding percentage stroke risk following AF put out by the otherwise excellent folk who run this site.

A percentage is meaningful only when given with context. The context here is complex but, at the very least, the percentage needs to be accompanied by a concrete reference to the numbers involved. The numbers who die within thirty days of surgery sounds alarming without concrete context - and I suspect (not knowing the actual numbers) that it isn't anything much to be concerned about given that surgery itself is rarely entered into lightly. There are so many variables to account for in the context: age, co-morbidities, reason for surgery, gender to name four. Even using matched controls, while important, brings with it a raft of further complications.

Steve

[Omniscient1]

Basically you have a 6% chance of dying after a heart op. Those of us in this forum have an 8% chance. It's not good, but it's starting from a bad place anyway.If you need a heart op you may not be in good shape anyway.

Interesting post, thanks.

[Chinkoflight]

Hi TikaTora, 31% sounds a big number, but I guess the actual mortality rate is still low. With an existing condition like Afib I would imagine just about every subsequent health risk raises an absolute risk rate. However many people live with Afib without a problem. I think it's helpful to give a link to the research when highlighting a statistic that might give rise to unnecessary anxiety so that the headline being created can be properly understood.

[Chrisdave]

I'm in permanent Afib (no sinus rhythm) and am having a so called "minor opp" to remove a small lump from my lower arm in a little over a weeks time.This article has made me even more nervous than I was before not least by coming off the Rivaroxaban 3 days before for I know not how long after?

Quite worrying!

[TikaTora in reply to Chrisdave]

I did not mean to cause worry or start a debate with posting this document, as for myself I would still go ahead with my hip operation if the anaesthetist would commit to carrying it out.

[Chrisdave in reply to TikaTora]

Yes, thanks, its a case of all things considered and being guided

[Dudtbin]

my husband has had both hips replaced and nobody mentioned his af except to say don’t take anticoagulant the day before!

[Sharonsue]

Well...thank you Jesus. I was diagnosed with afib in Feb 2020. I had a left hip replacement in May 2020...then the right hip replacement in Oct. 2020. I am 74 yrs. old. I am so thankful I had these surgeries.

[FSsimmer]

What can you do about it??...If your Afib has been diagnosed and is adequately treated, then Drs would do a risk assessment prior to surgery. There are always risks, but they will do their best to mittigate them. If its life saving surgery for another condition, and you have a choice you can either agree to it or take your chances because you may have increased complications. Again, your choice re the hip. if you can live with the pain and mobility issues, then elect not to have the surgery

[JOY2THEWORLD49]

Hi

But it sounds they included those with AF UNCONTROLLED. My Anaesthetists wouldn't carry out an operation if my H/R was over 100 uncontrolled.

CCB saved me to be under 100.

But my thyroidectomy plus 12 lymphs taken was done uncontrolled. I had 2 Anaesthetists.

The surgeon wished me to start back on PRADAXA the morning after my recent right shoulder operation. But the Anaesthetist said no, the following day which I followed.

The risk is stopping the anti-co-agulant 3 days prior and then the right time to restart them. A clot/s being the risk.

I've had 3 operations since my stroke with diagnosed AF September 2019. I have been fine.

I doubt whether the risk above has anything to do with the cancellation. Perhaps out of the 2 procedures/operation the cardiac team want you to have procedure for AF first.

cheri JOY