Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery

Clinical practices for defining, detecting, and diagnosing postoperative atrial fibrillation after coronary revascularization surgery - A scoping review

OBJECTIVES

This scoping review was undertaken to understand the degree of variation in clinical practices associated with postoperative atrial fibrillation (POAF), following coronary revascularization surgery by collating and synthesising key concepts from current published literature.

REVIEW METHODS AND DATA SOURCES

This scoping review was conducted following the framework outlined by Askey and O'Malley. Reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Initial searches were completed in September 2020 and updated in January 2023. Comprehensive searches to identify relevant published literature were carried out within CINAHL, MEDLINE, and ProQuest databases. All searches were limited to full-text papers published in English with human adult participants. Deductive content analysis using NVivo software was performed to synthesise the data.

RESULTS

A total of 692 studies were identified during the database searches. After the deletion of duplicates and the application of the inclusion and exclusion criteria, 73 studies were included in the scoping review. The included studies were published between 2001 and 2022 and included a total of 24,833 participants. Forty-six studies included a definition of POAF, with four of these citing a peak-body definition. A total of 24 included studies reported on electrocardiogram diagnostic criteria for POAF, with 13/24 [54%] describing these characteristics within their definition. The time-based diagnostic criteria ranged from a minimum duration of greater than 30 seconds to greater than 1 hour. The most frequently reported minimum-time thresholds were ≥30 seconds, reported in 12 of 51 (24%) studies and ≥5 min, reported in 13 of 51 (25%) studies.

CONCLUSIONS

There is a lack of consistency in clinical practice for defining, detecting, and diagnosing POAF, following coronary revascularization surgery. Consensus and standardisation of clinical practices are urgently needed.

Elucidation of the novel role of ethnicity and diabetes in poorer outcomes after cardiac surgery in a multiethnic Southeast Asian cohort

BACKGROUND

Although diabetes is associated with ethnicity and worse cardiac surgery outcomes, no research has been done to study the effect of both diabetes and ethnicity on cardiac surgery outcomes in a multiethnic Southeast Asian cohort. Hence, this study aimed to delineate the association of ethnicity on outcomes after cardiac surgery among diabetics in a multiethnic Southeast Asian population.

METHODS

Perioperative data from 3008 adult patients undergoing elective cardiac surgery from 2008 to 2011 at the two main heart centers in Singapore was analyzed prospectively, and confirmatory analysis was conducted with the generalized structural equation model.

RESULTS

Diabetes was significantly associated with postoperative acute kidney injury (AKI) and postoperative hyperglycemia. Postoperative AKI, Malay ethnicity, and blood transfusion were associated with postoperative dialysis. Postoperative AKI and blood transfusion were also associated with postoperative arrhythmias. In turn, postoperative dialysis and arrhythmias increased the odds of 30-day mortality by 7.7- and 18-fold, respectively.

CONCLUSIONS

This study identified that diabetes is directly associated with postoperative hyperglycemia and AKI, and indirectly associated with arrhythmias and 30-day mortality. Further, we showed that ethnicity not only affects the prevalence of diabetes, but also postoperative diabetes-related outcomes.