A Prospective Clinical Audit to Improve Compliance With Perioperative Atrial Fibrillation Prevention Protocols in Off-Pump Coronary Artery Bypass Surgery

Background New-onset atrial fibrillation (AF) is a frequent complication following cardiac surgery and is associated with significant mortality and morbidity. This audit evaluated adherence to perioperative AF prevention standards and the effect of targeted quality-improvement measures in off-pump coronary artery bypass grafting (OPCAB) patients. Methodology Two prospective audit cycles were performed at the Apollo Imperial Hospitals. Cycle 1 (January to September 2024; n=95 eligible) established baseline compliance with three standards: the continuation of beta-blocker on the morning of surgery, maintenance of perioperative serum potassium at 4.5-5.0 mmol/L, and reinstitution of beta-blocker within 12 hours postoperatively. After multidisciplinary interventions (permanent ICU/OR posters, checklist attached to patient records, weekly team meetings, and four-times-daily ward rounds), improvement was assessed in cycle 2 (November 2024 to July 2025; n=101). Bisoprolol was the institutional beta-blocker; ivabradine was used if beta-blockers were contraindicated. Categorical variables were analyzed using the chi-square test or Fisher's exact test, and relative risk (RR) and odds ratios (OR) were estimated with 95% confidence intervals (CI). Results Preoperative beta-blocker continuation improved from 66.3% to 94.1% (p