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Page 10 of 11 Hawkins et al. Vessel Plus 2022;6:42 https://dx.doi.org/10.20517/2574-1209.2021.116

The limitations of this study include its retrospective nature with the risk of selection bias and the inability
to determine causality. Risk adjustment was performed using propensity matching, although this does not
account for unmeasured confounders. One important unmeasured factor is perioperative hemodynamics,
which is unfortunately not available within the regional STS database. This missing information limits a
specific analysis of how POAF increases the length of stay, whether that is from hemodynamic instability,
anti-arrhythmic or anticoagulation initiation, or other unmeasured aspects of care. While we have data on
discharge medications, we do not know the conversion rate and the number of patients discharged in sinus
[17]
rhythm, although this can be expected to be 95% . Data incompleteness is another inherent limitation of
database studies, and the number of patients identified with preoperative atrial fibrillation may be a small
[17]
underestimate at 3.6% . Finally, only short-term outcomes could be analyzed due to the limited data
available in all STS-related databases.

In conclusion, in this regional analysis of the Southeastern United States, postoperative atrial fibrillation was
associated with between $4407 and $6705 in total hospital costs after adjusting for baseline risk and other
postoperative complications. Nearly all component costs were similarly higher for patients with POAF. The
additional $3159 in total stay costs were driven by an increased length of stay of 2 days overall, and 9 h in
the ICU. The increase in resource utilization extends beyond the index hospitalization, including increased
discharges to a facility and a higher number of readmissions. These results reinforce the continued
monetary and clinical impacts of postoperative atrial fibrillation on cardiac surgery patients and providers.

DECLARATIONS
Authors’ contributions
Design of the study: Hawkins RB, Strobel RJ, Joseph M, Quader M, Teman NR, Almassi GH, Mehaffey JH
Acquisition of data: Hawkins RB
Analysis and interpretation of data: Hawkins RB
Drafting of manuscript: Hawkins RB
Critical revisions: Hawkins RB, Strobel RJ, Joseph M, Quader M, Teman NR, Almassi GH, Mehaffey JH
Approval of manuscript: Hawkins RB, Strobel RJ, Joseph M, Quader M, Teman NR, Almassi GH, Mehaffey
JH

Availability of data and materials
Not available.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.