A recent study conducted at the University of Rochester suggests that aging adults who undergo elective noncardiac surgeries too soon after experiencing a heart attack face a significantly higher risk of life-threatening complications. Research involving 5.2 million surgeries from 2017 to 2020 focused on patients aged 67 and older who had suffered a non-ST-segmented elevation myocardial infarction (NSTEMI). The findings indicated that delaying surgery for three to six months post-heart attack could potentially reduce the risk of complications such as strokes or subsequent heart attacks.
The primary objective of the study was to determine the optimal timing for scheduling additional surgical procedures for this high-risk population. The data analyzed in the study aimed to provide updated information that could support changes to existing decision-making guidelines, which were established over two decades ago. Lead author Laurent Glance emphasized the importance of clinicians having access to the most current data to inform patient care decisions. The study’s results challenge the current recommendation of waiting 60 days after a heart attack before undergoing elective noncardiac surgery, as established by the American College of Cardiology and American Heart Association in 2014.
According to the study’s findings, the majority of post-surgical deaths or significant complications occur within the first 30 days post-operation. Perioperative teams strive to prevent these adverse outcomes by closely monitoring patients during the initial recovery period. The analysis revealed a decline in risk during the first 90 days after surgery, followed by a stabilization of risk for the subsequent 180 days. Given that aging patients often present with multiple acute or chronic conditions, physicians must carefully balance the risks associated with surgical intervention against the patient’s expectations for improved quality of life.
The challenge for perioperative teams lies in evaluating a wide array of health and lifestyle factors to assess a patient’s risk and optimize their outcomes. Co-author Marjorie Gloff, Director of URMC’s Center for Perioperative Medicine, highlighted the complexity of managing patients who may be eager to proceed with joint replacement surgery after surviving a heart attack. The study underscored the need for a comprehensive and individualized approach to risk assessment in this vulnerable population. Additional co-authors from various institutions contributed to this research, which was supported by funding from the National Institute of Aging, National Institute of Nursing Research, and URMC’s Department of Anesthesiology and Perioperative Medicine.
Overall, the study’s findings suggest that delaying elective noncardiac surgeries for three to six months following a heart attack could significantly reduce the risk of life-threatening complications in aging adults. The research provides valuable insights into the optimal timing for scheduling additional surgical procedures in this high-risk population, challenging existing guidelines that were established over 20 years ago. Moving forward, clinicians and perioperative teams must consider the latest data to inform their decision-making and provide the best possible care for patients facing complex health challenges.
