Adverse Events after Pelvic Organ Prolapse Surgery in Older Women with Atrial Fibrillation

Objectives: To examine whether atrial fibrillation (AF) in older women increases the risk of adverse events (AEs) within 8 weeks of pelvic organ prolapse (POP) surgery. Materials and Methods: This is a secondary analysis of a retrospective study examining perioperative AEs in women aged ≥61 years undergoing major POP surgery from January 2016 to May 2023 at a single academic center. We identified patients with a preoperative diagnosis of AF and matched them with a cohort of patients without AF in a 1:3 fashion by age and Charlson Comorbidity Index score. Composite perioperative AEs within 8 weeks of POP surgery were compared between the groups, and a multivariable logistic regression was performed, controlling for variables with p < 0.05 on univariable analysis. Results: There were 80 patients with AF and 240 patients without AF in the matched cohort. Patients with AF were more likely to be on an anticoagulant preoperatively (63.8% vs. 7.6%, p < 0.01) and have a prior hysterectomy (52.5% vs. 36.7%, p = 0.01). Composite perioperative AEs did not differ between the two groups, although risk of surgical site infection was higher in the AF group (5.0% vs. 0.8%, p = 0.04). On multivariable analyses controlling for preoperative anticoagulant use and prior hysterectomy, there was no association between composite AEs and AF. However, preoperative anticoagulant use was associated with a 2.14 higher adjusted odds of AEs after POP surgery (95% CI = 1.02–4.46). Conclusions: Although AF did not increase overall risk of perioperative AEs within 8 weeks of POP surgery, preoperative anticoagulant use was associated with a greater odds of perioperative AEs. These findings can assist reconstructive pelvic surgeons with surgical planning and counseling in older patients with AF.