New-Onset Perioperative Atrial Fibrillation Is Associated with Increased All-Cause Mortality in Elderly Patients Undergoing Total Knee and Hip Replacements

Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgeries performed in elderly patients with osteoarthritis. Limited data address the clinical significance of perioperative atrial fibrillation (AF) in these patients. This study aimed to determine whether preexisting or new-onset AF is associated with increased 1-year all-cause mortality rates in the elderly population. Methods: 280 patients over the age of 60 undergoing THA or TKA with perioperative AF and 280 control-matched patients were retrospectively identified, and their files reviewed. The primary end point was 1-year all-cause mortality from the date of the surgery. Results: Of the 280 patients with perioperative AF, 37 had new-onset AF with a 1-year all-cause mortality rate of 10.8%. This mortality was significantly higher in patients with new-onset AF compared to patients without AF or patients with previous AF (10.8% vs. 1.1% and 2.5%, respectively; p = 0.005). On multivariate analysis, this difference remained significant after adjustment for risk factors associated with all-cause mortality. Conclusions: One-year all-cause mortality in elderly patients undergoing TKA or THA is significantly increased in the patients that develop new postoperative AF. These patients warrant increased clinical surveillance following surgery.