Postoperative Atrial Fibrillation: Evaluation of its Economic Impact on the Costs of Cardiac Surgery

Abstract Objective: The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital. Methods: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication. Results: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups. Conclusion: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

摘要
研究目的：本研究旨在计算某高复杂度心血管专科医院中术后心房颤动（postoperative atrial fibrillation, POAF）的直接医疗成本。
研究方法：本研究采用配对设计开展成本分析，共纳入22例POAF患者与22例未发生该并发症的患者，按照1:1比例进行配对匹配，匹配标准包括手术类型完全一致、欧洲心脏手术风险评估系统II（EuroSCORE II）评分相近、无其他术后并发症。
研究结果：POAF组患者的总住院费用显著高于非POAF组，人均分别为10880美元（标准差±2688美元）与8856美元（标准差±1782美元，P=0.005）。该差异主要源于术后医疗成本：POAF组与非POAF组患者的术后成本分别为3103美元（±1552美元）与1238美元（±429美元，P=0.0001）。POAF组与非POAF组患者的术后中位住院时长分别为9天（范围5~17天）与5天（范围3~9天，P=0.032）。术前，两组患者的EuroSCORE II评分（中位值分别为1.7与1.6，P=0.91）与直接医疗成本（分别为1127美元与1063美元，P=0.56）均无显著差异。
结论：术后心房颤动会显著增加心脏手术整体治疗的经济负担，本研究结果揭示了各评估因素的差异化贡献。此类此前在该医疗机构中尚未被获取的相关数据，对于制定更高效的预防策略具有重要价值。