After a heart attack, aging adults face double or triple the risk of life-threatening complications — like a debilitating stroke or another heart attack — when they move forward with elective noncardiac surgeries too soon, according to new University of Rochester research published in JAMA Surgery.
A deep dive into the Medicare database of 5.2 million surgeries from 2017 to 2020 for patients 67 and older suggests delaying surgery for three to six months following a heart attack, known as a non-ST-segmented elevation myocardial infarction (NSTEMI).
Researchers aim to identify the “sweet spot” for safely scheduling additional surgical procedures in this high-risk population. The study provides valuable analysis to support changes to decision-making guidelines set more than 20 years ago.
“The data physicians are using for patient care decisions today is outdated. Given the advances in care and the ever-changing mix of patients, clinicians need the latest information,” said Laurent Glance, MD, lead author and professor of Anesthesiology and Perioperative Medicine and Public Health Sciences at the University of Rochester Medical Center (URMC).
The 2014 American College of Cardiology and American Heart Association perioperative guidelines call for waiting 60 days after a heart attack before undergoing an elective noncardiac surgery. The recommendation was based on a study of 500,000 patients between 1999 and 2004.
Most post-surgical deaths or significant complications occur during the first 30 days of recovery and perioperative teams work diligently to prevent them. This new analysis shows a decline in risk during the first 90 days, when it leveled off for the next 180 days.
Aging patients often have multiple acute or chronic conditions, and physicians are challenged to balance their risk of surgical care with their expectations for quality of life.
“Perioperative teams analyze a variety of health and lifestyle factors when we assess a patient’s risk and work to optimize their outcomes,” said Marjorie Gloff, MD, a co-author and director of URMC’s Center for Perioperative Medicine. “It can be frustrating for individuals who suffer with joint pain to postpone a long-awaited knee or hip replacement after surviving a heart attack.”
Additional co-authors include Gloff, Heather Lander, MD, Stewart Lustik, MD, Michael Eaton, MD, Sabu Thomas, MD, of URMC; Mark Sorbero, MS, and Andrew Dick, PhD, of RAND Health; Karen E. Joynt Maddox, MD, MPH, of Washington University; Lee Fleisher, MD, of University of Pennsylvania; and Jingjing Shang, PhD, RN, and Patricia Strong, PhD, RN, of Columbia School of Nursing.
This study was supported by funding from the National Institute of Aging, National Institute of Nursing Research and URMC’s Department of Anesthesiology and Perioperative Medicine.