SRS173 - The impact of preexisting atrial fibrillation on early outcomes following symptomatic carotid endarterectomy: a national analysis of 17 440 cases

Abstract Background Atrial fibrillation (AF) increases perioperative risk in noncardiac surgery, but its influence on early outcomes following symptomatic carotid endarterectomy (sCEA) remains unclear. This study evaluates the association between established AF and 30-day postoperative morbidity after sCEA. Methods We retrospectively analysed 17 440 sCEA procedures submitted to the UK National Vascular Registry (2021–2023), including 1791 patients (9.1%) with documented AF. Group differences were assessed using Mann–Whitney U and Spearman's rank tests. Multivariable and binary logistic regression evaluated the independent effect of AF on postoperative complications. Results AF patients were older (76.8 versus 71.5 years, P < 0.01), more often male (73.2% versus 67.1%, P < 0.01), and had greater cardiovascular and renal comorbidity (all P < 0.01). AF was not associated with increased 30-day stroke or mortality rates, nor with operative complications such as wound infection or return to theatre. However, AF independently predicted higher rates of postoperative cardiac events (P < 0.01) and prolonged hospital stay (P < 0.01), without affecting ITU duration, renal or respiratory complications, or readmission rates. Conclusions Preoperative AF does not increase the risk of stroke or death following sCEA but is independently associated with increased cardiac morbidity and extended hospitalisation. These findings support tailored perioperative planning and anticoagulation strategies for AF patients undergoing sCEA.