MODIFIED: LOE was updated from C to B-NR because of new evidence. Recommendation-Specific Supportive Text (Modified) 1. New evidence exists supporting surgical LAA occlusion in patients with a history of AF. An observational study evaluated the association between surgical LAA occlusion (usually with sur- gical atrial ablation) performed concurrently with cardiac operations in older patients with a history of AF and the risk of postoperative thromboem- The authors used patient information from the Society of Thoracic Surgeons Adult Cardiac Surgery Database registry, which contains perioperative information with short- term (mainly 30-day) outcomes. The study linked the Society of Thoracic Surgeons Adult Cardiac Surgery Database patient information to Medicare claims data (age 65 years), with the primary out- come of readmission within 3 years of operation for thromboembolism (stroke, transient ischemic attack, or systemic embolism). The study identi- fied 10524 patients who underwent cardiac sur- gical procedures, including 3892 patients (37%) with surgical LAA occlusion. At a mean follow-up of 2.6 years, surgical LAA occlusion, compared with no LAA occlusion, was associated with lower unadjusted rates of readmission for thromboem- bolism (4.2% versus 6.2%), all-cause mortality (17.3% versus 23.9%), and the composite end- point (20.5% versus 28.7%) but no significant difference in rates of hemorrhagic stroke (0.9% each). These findings suggest that surgical LAA occlusion may be associated with reduced post- operative thromboembolic events in older patients with a history of AF. In subgroup analyses stratified by anticoagulation status at hospital discharge, patients with a history of AF who received LAA occlusion without postoperative anticoagulation had a significantly lower thrombo- embolism rate than those who received neither LAA occlusion nor anticoagulation. 