Single-Center Incidence of Post-CABG Atrial Fibrillation: Development and Implementation of a Prevention Care Bundle

Abstract 2316437, presented at Western Atrial Fibrillation Symposium 2026

Post-operative atrial fibrillation (POAF) occurs in 25-48% of coronary artery bypass grafting (CABG) patients and is associated with increased mortality, stroke, renal failure, and hospital length of stay. We conducted a multiphase quality improvement initiative to evaluate POAF incidence and outcomes at Texas Health Presbyterian Denton (THDN) compared to national benchmarks.We retrospectively analyzed 364 consecutive isolated CABG cases from 2023-2025 using Society of Thoracic Surgeons (STS) metrics. Observed-to-expected (O/E) ratios were calculated for operative mortality, and complications rates. Phase 1 focused on identifying performance gaps; Phase 2; currently in process; will implement an evidence-based prevention protocol.POAF incidence was 42% (2023), 32% (2024), and 34% (2025), all above the 25% national benchmark. In 2024, THDN demonstrated exceptional rescue effectiveness despite elevated complication rates: operative mortality O/E improved from 1.74 to 0.61 (65% reduction), renal failure O/E decreased from 3.32 to 0.62 (81% reduction), and prolonged ventilation O/E decreased from 1.24 to 0.42 (66% reduction). Deep sternal wound infection O/E improved from 3.28 to 0.0. However, stroke O/E increased to 2.72. In 2025, concerning deterioration occurred: operative mortality O/E increased to 1.99, deep sternal wound infection O/E rose to 4.59, and renal failure O/E increased to 1.84, despite POAF remaining below 2023 levels. Stroke O/E improved to 0.0. Median ventilation time remained below 6-hour benchmarks throughout (4.4-4.9 hours). Discharge-to-home rates improved from 77% to 82%.THDN's 2024 outcomes demonstrated that superior rescue capabilities can mitigate POAF-associated complications more effectively than complication prevention alone, consistent with national FTR data. The 2025 regression suggests system-level factors affecting multiple O/E ratios simultaneously. Phase 2 will implement standardized protocol including: CHA‚ÇÇDS‚ÇÇ-VASc risk stratification, periop beta-blockers, prophylactic amiodarone for high-risk patients, posterior pericardiotomy, magnesium supplementation, & high-intensity statins as appropriate. Root cause analysis of 2025 deterioration & replication of 2024 success factors are essential. Ongoing measurement will assess protocol effectiveness in reducing POAF incidence and improving rescue outcomes.