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J. Fontaine



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    Poster Display Session (ID 63)

    • Event: ELCC 2017
    • Type: Poster Display Session
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 5/07/2017, 12:30 - 13:00, Hall 1
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      63P - Diabetes predisposes patients to atrial fibrillation after robotic-assisted video-thoracoscopic pulmonary lobectomy (ID 514)

      12:30 - 13:00  |  Author(s): J. Fontaine

      • Abstract

      Background:
      Pre-existing diabetes has been described as a risk factor for the development of atrial fibrillation (AFib) following non-cardiac surgery. This study aimed to determine if diabetes and associated comorbidities increase the risk of AFib following robotic-assisted pulmonary lobectomy and improve risk stratification of diabetics.

      Methods:
      Excluding patients with preoperative history of AFib, 353 consecutive patients who underwent robotic-assisted video thoracoscopic (RAVTS) lobectomy by one surgeon from October 2010 to August 2016 were retrospectively analysed. Patients were studied with respect to the presence of diabetes, coronary artery disease, heart failure, kidney failure, peripheral vascular disease, and other known associated comorbidities. Chi-Square (X[2]), Fisher’s exact test, and Student’s t-test were used to compare variables, with significance at p ≤ 0.05.

      Results:
      In this study, 64 patients with diabetes were identified, 11 (17.2%) of whom developed AFib following RAVTS lobectomy. Patients with diabetes were at higher risk of developing of AFib following surgery (OR 2.52, 95% CI 1.15 to 5.50, p = 0.02). The average age of diabetics who developed AFib was 72.7 years and 68.4 years for those who did not (p = 0.07). Known comorbidities in patients with diabetes did not confer additional risk, including hypertension (p = 1.00), hyperlipidaemia (p = 1.00), cardiomyopathy (p = 0.17), coronary artery disease (p = 0.27), and obesity (p = 0.67). There was a trend toward increased risk in diabetics with kidney disease, although it failed to reach significance (p = 0.07). Being a former smoker was the only independent risk factor identified, as 90.9% of diabetics with AFib were former smokers (OR 10.38, 95% CI 1.24 to 86.95, p = 0.03). Pack-years did not increase risk for AFib, with 47.2 pack-years on average being reported in those who developed AFib, while patients without AFib averaged 49.6 pack-years (p = 0.87). Furthermore, there was no significant difference in pre-operative percent forced expiratory volume in 1 second of diabetics who did and did not develop AFib (87.0% vs 80.4%, p = 0.45).

      Conclusions:
      Patients with diabetes are at higher risk for developing AFib after RAVTS lobectomy. Known comorbidities of diabetes, including obesity, hyperlipidaemia, and kidney disease, did not confer an increased risk for the development of AFib after surgery; however, being a former smoker puts diabetics at 10-times greater risk than current or never smokers with diabetes.

      Clinical trial identification:
      Not applicable.

      Legal entity responsible for the study:
      Eric M. Toloza, M.D., Ph.D.

      Funding:
      Moffitt Cancer Center and University of South Florida Health Morsani College of Medicine

      Disclosure:
      J. Fontaine, E. Toloza: Honoraria as robotic thoracic surgery observation site and proctor for Intuitive Surgical Corp. All other authors have declared no conflicts of interest.

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      64P - Smoking history as a risk factor for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy (ID 515)

      12:30 - 13:00  |  Author(s): J. Fontaine

      • Abstract

      Background:
      Smoking history has been correlated to the development of atrial fibrillation (AFib) after noncardiac thoracic surgery, increasing hospital length of stay, post-operative mortality, and costs. This study sought to determine the effects of smoking history and pulmonary function on the development of AFib following robotic-assisted pulmonary lobectomy to allow for more targeted dispositioning of post-lobectomy patients.

      Methods:
      We retrospectively analysed 353 consecutive patients without history of AFib who underwent robotic-assisted video thoracoscopic (RAVTS) lobectomy by one surgeon from October 2010 to August 2016. Patients were analysed with respect to smoking status, pack-years, months of smoking cessation, and pulmonary function. Chi-Square (X[2]), Fisher’s exact test, and Student’s t-test were used to compare variables, with significance at p ≤ 0.05.

      Results:
      In our study, 17 of 144 men (11.8%) and 16 of 209 women (7.7%) experienced new-onset AFib following RAVTS lobectomy (p = 0.19). The average age of people who developed AFib was 72.8 years (yrs) and 66.4 yrs for those who did not (p < 0.001). Former smokers represented 72.7% of new AFib cases, current smokers 21.2%, and never smokers 6.1% (p = 0.009). Former smokers were at higher risk than both never (OR 5.30, 95% CI 1.22 to 23.09, p = 0.03) and current smokers (OR 2.62, 95% CI 1.09 to 6.31, p = 0.03). Former smokers who developed AFib also were older (74.6 vs. 69.1 yrs, p = 0.004) and more often diabetic (OR 3.27, 95% CI 1.31 to 8.17, p = 0.01). There was no difference in AFib rates for light (≤15 pack-years) and heavy (>15 pack-years) smokers (p = 0.21). Never smokers fared better than light (p = 0.02) but not heavy (p = 0.13) smokers. There was no difference in pack-years for former and current smokers who developed AFib (p = 0.11). For all groups, the development of AFib was independent of pre-operative pulmonary function as measured by percent of predicted forced expiratory volume in 1 second and percent of predicted diffusion capacity of the lung for carbon monoxide (p = 0.09 and 0.63, respectively). The development of AFib was also unaffected by the presence of COPD (p = 0.80).

      Conclusions:
      Former and light smokers are at higher risk than both current and never smokers for developing AFib after RAVTS lobectomy, independent of pack-years and pre-operative pulmonary function. Duration of smoking cessation prior to lobectomy does not change the likelihood of developing AFib.

      Clinical trial identification:
      Not applicable.

      Legal entity responsible for the study:
      Eric M. Toloza, M.D., Ph.D.

      Funding:
      Moffitt Cancer Center and University of South Florida Health Morsani College of Medicine

      Disclosure:
      J. Fontaine, E. Toloza: Have received honoraria as robotic thoracic surgery observation site and proctor for Intuitive Surgical Corp. All other authors have declared no conflicts of interest.

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      66P - Effect of age on risk for atrial fibrillation following robotic-assisted video-thoracoscopic pulmonary lobectomy (ID 517)

      12:30 - 13:00  |  Author(s): J. Fontaine

      • Abstract

      Background:
      Aging is a known risk factor for several post-operative comorbidities, including atrial fibrillation (AFib), leading to increased length of stay and mortality. This study was designed to investigate the effect of age and related comorbidities on new-onset atrial fibrillation after robotic-assisted pulmonary lobectomy to better identify patients at greatest risk.

      Methods:
      We conducted a retrospective analysis of 353 consecutive patients without history of preoperative AFib who underwent robotic-assisted video-thoracoscopic (RAVTS) lobectomy by one surgeon from October 2010 to August 2016. Patients were analysed with respect to age and associated comorbidities, such as hypertension, hyperlipidaemia, and diabetes. Chi-Square (X[2]), Fisher’s exact test, and Student’s t-test were used to compare variables, with significance at p ≤ 0.05.

      Results:
      The average age of participants who developed post-operative AFib (n = 33) was significantly higher, 72.8 years (yrs) vs. 66.4 yrs (p < 0.001). There was a decreased risk in patients under 70 yrs, with only 11 (5.3%) developing AFib (OR 0.31, CI 0.14-0.66, p = 0.002). By contrast, 22 (15.3%) of the elderly (age ≥70 yrs) experienced new-onset A-fib (OR 2.54, 95% CI 1.19 to 5.41, p = 0.02). Those under 60 yrs were at least risk (OR 0.10, 95% CI 0.01 to 0.75, p = 0.02), and those ≥80 yrs were at greatest risk (OR 2.74, 95% CI 1.03 to 7.28, p = 0.04). While the elderly in our cohort had a higher rate of many well-described comorbidities, including hypertension, hyperlipidaemia, coronary artery disease, and cardiomyopathy, none of these conferred an increased risk of post-operative AFib. Among those over 70 yrs, only BMI, particularly an obese BMI (≥30 kg/m[2]), led to a higher risk (p = 0.02 and p = 0.003, respectively). Among the elderly, obese patients developed AFib at 2.3 times the rate of those with normal or overweight BMI’s (OR 4.21, 95% CI 1.66 to 10.68, p = 0.002). Conversely, only being a former smoker increased the risk of AFib in those under 70 yrs (OR 4.79, 95% CI 1.23 to 18.70, p = 0.02). The risk in former smokers was independent of pack-years and duration of cessation prior to surgery. Furthermore, the risk of AFib was not significantly affected by intra-operative complications in either group.

      Conclusions:
      Patients aged 70 years or older are at increased risk of AFib after RAVTS lobectomy, particularly if they are obese. Those under 70 years are at increased risk if they are former smokers.

      Clinical trial identification:
      Not applicable.

      Legal entity responsible for the study:
      Eric M. Toloza, M.D., Ph.D.

      Funding:
      Moffitt Cancer Center and University of South Florida Health Morsani College of Medicine

      Disclosure:
      J. Fontaine, E. Toloza: Have received honoraria as robotic thoracic surgery observation site and proctor for Intuitive Surgical Corp. All other authors have declared no conflicts of interest.