J. A. Munoz Largacha1, K. He1, C. A. Lafon1, J. M. Donahue1, B. Wei1 1University Of Alabama at Birmingham, Cardiothoracic/Surgery, Birmingham, Alabama, USA
Introduction: To determine whether prophylaxis with oral diltiazem is associated with a lower rate of atrial fibrillation in patients undergoing robotic lobectomy.
Methods: A retrospective review of all robotic lobectomies performed at our institution between January 1st of 2012 and December 19th of 2019 was conducted. Patients with a prior medical history of atrial fibrillation or current beta-blocker use were excluded. Patients were divided into two cohorts: before and after we began the use of prophylactic oral diltiazem, which was added to the postoperative care protocol in August of 2014. Group 1 included patients who underwent surgery before the protocol change; group 2 included patients who underwent robotic lobectomy after the protocol change AND received oral diltiazem after surgery. A dose of 30 or 60mg was given post-operatively after arrival to the floor from the recovery area, and continued every 6 hours until discharge. Statistical analysis was performed using student T-test for nominal variables and Chi-Square test for categorical variables.
Results:A total of 622 patients underwent robotic lobectomy during the study period. After excluding patients with a history of atrial fibrillation (n=48), current beta-blocker use (n=144), and patients who did not actually receive postoperative diltiazem (n=101), 329 patients remained, with 133 patients in Group 1 and 196 patients in group 2. No significant differences were evidenced when comparing patient demographics. Mean age for group 1 was 64 years ±11.9 vs 63 ±11.5 in group 2 (p=0.2). Sixty-six percent were males in group 1 vs 79% in group 2 (p=0.09). Smoking status (current/former/never) was similar between both groups (p=0.9). There was no difference with regards to the side and location of operation with 69% right lobectomies in group 1 vs 66% in group 2 (p=0.4). The length of stay was also similar (4.2±6.1 days in group 1 vs 3.5±3.9 days in group 2, p=0.1). There was no significant difference in the rate of postoperative atrial fibrillation between group 1 and group 2 (7% (9/133) vs. 8% (16/196) p=0.6) (Table).
Conclusion: Atrial fibrillation prophylaxis with diltiazem in patients undergoing general thoracic surgery has been described in the literature, however, this has not been studied after robotic operations. In this study, prophylaxis with oral diltiazem for patients undergoing robotic lobectomy was not associated with a lower rate of post-operative atrial fibrillation when compared with patients not receiving diltiazem prophylaxis. These results suggest that oral diltiazem for the prophylaxis of atrial fibrillation after robotic lobectomy may not be beneficial.
