Impact of AF in Patients Undergoing Colectomy for IBD

In a study published in Cureus, researchers examined the effects of atrial fibrillation (AF) in patients with inflammatory bowel disease (IBD) undergoing a segmental or total colectomy—citing previous evidence linking inflammation to the development of AF. The researchers, led by Ratib Mahfouz, concluded that colectomy patients with IBD and concomitant AF exhibited increased mortality and morbidity.

Using the National Inpatient Sample database, the investigators enrolled 2,045 patients with IBD and AF who underwent a colectomy between 2016 and 2019. T-tests, chi-square tests, and univariable and multivariable logistic regression analyses were used to evaluate outcomes and the effect of AF.

In the study, researchers found the mortality rate in patients with AF undergoing colectomy for IBD was significantly higher than in patients without AF, at 13.45% versus 2.69%, respectively (P<.001). The authors noted that their multivariate analysis supported this association with an adjusted odds ratio (aOR) of 2.27 (P<.001).

Atrial Fibrillation Negatively Impacts Colectomies for Patients with IBD

In addition, patients with AF had a significantly longer mean length of stay (16.79 days) compared with patients without AF (11.24 days; P=.001), and patients with AF had significantly higher hospitalization costs ($222,109 vs. $142,011; P<.001). The presence of AF was also identified as a major driver in need for mechanical ventilation (aOR, 2.05; 95% confidence interval, 1.48-2.84; P<.001).

Other factors which increased the OR for mortality in the cohort included:

• age of 65 years or more (P=.001)
• female gender (P=.002)
• non-White race (P=.027)
• diabetes (P=.004)
• chronic kidney disease (P<.001)
• chronic obstructive pulmonary disease (P<.001)
• coronary artery disease (P=.015)

The article noted the study was limited by the use of ICD-10-CM codes for disease diagnoses, as they could be erroneous, and the fact that each admission was considered separately even if it was for a previously admitted patient—which affected the analysis as it considered single admissions with both IBD and colectomies.

Nonetheless, the researchers concluded that systemic inflammation from IBD “can be linked to the development and persistence of AF which can explain the increased incidence of AF in IBD patients.”

They ultimately suggested their findings “can guide physicians to allocate more time for optimizing the management of AF in this group of patients to decrease the risk of complications, length of stay, and overall mortality.”

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