Prevalence and risk factors for postoperative atrial fibrillation following pulmonary resection: a systematic review and meta-analysis

Objective This study aimed to perform a meta-analysis integrating multiple sources to investigate risk factors for postoperative atrial fibrillation (POAF) in patients undergoing pulmonary resection (PR). Methods We searched English databases (PubMed, Cochrane Library, Embase, Web of Science (WOS)) and Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, Sinomed) up to September 25, 2025. Observational studies utilizing multivariate logistic regression to analyze the prevalence and risk factors of atrial fibrillation (AF) following PR were selected. Meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted, and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using STATA 15.0. Results Eighteen studies involving 25,238 patients were included, among whom 1,967 developed POAF, yielding a prevalence of 7.79%. Meta-analysis revealed significant associations between POAF and the following risk factors: Age (OR = 1.04, 95% CI: 1.01–1.06, p = 0.011), Age ≥ 65 years (OR = 2.92, 95% CI: 2.02–4.23, p < 0.001), Male (OR = 1.93, 95% CI: 1.46–2.56, p < 0.001), Hypertension (OR = 1.34, 95% CI: 1.14–1.57, p < 0.001), Lymph node dissection (OR = 2.18, 95% CI: 1.12–4.24, p = 0.021), Thoracotomy (OR = 1.71, 95% CI: 1.40–2.09, p < 0.001), Lobectomy (OR = 2.68, 95% CI: 1.05–6.81, p = 0.039), Pneumonectomy (OR = 4.33, 95% CI: 2.12–8.84, p < 0.001), Operative time (minutes) (OR = 1.05, 95% CI: 1.01–1.09, p = 0.026), History of hyperthyroidism (OR = 5.67, 95% CI: 1.97–16.32, p < 0.001), Pre-existing atrial fibrillation (Pre-existing AF) (OR = 15.79, 95% CI: 4.69–53.13, p < 0.001), Red blood cell transfusion (OR = 2.78, 95% CI: 2.22–3.47, p < 0.001). No significant association was found with video-assisted thoracoscopic surgery (VATS) (OR = 1.02, 95% CI: 0.29–3.61, p = 0.97). Conclusion This study suggests that POAF following PR is associated with multiple patient- and surgery-related risk factors, many of which are identifiable preoperatively. Pre-existing AF was identified as the strongest predictor among the factors analyzed. These findings support the rationale for integrating preoperative risk assessment into the planning of individualized postoperative monitoring and prevention strategies, which may help improve clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-026-04093-x.