Database Analysis Helps Identify “Sweet Spot” for Safe Surgery after Heart Attack

The 2014 perioperative guidelines from the American College of Cardiology and the American Heart Association recommend waiting 60 days after a heart attack before proceeding with elective noncardiac surgery. This recommendation was derived from a study involving 500,000 patients between 1999 and 2004. Most deaths or significant complications that occur post-surgery happen within the first 30 days of recovery, prompting perioperative teams to work diligently to mitigate these risks. Aging patients frequently present with multiple acute or chronic conditions, which challenges physicians to balance the risks associated with surgical care against the patients' expectations for quality of life. A new study now suggests that postponing elective procedures by three to six months after a heart attack may lower the risk of complications for older adults. This research, published in JAMA Surgery, offers critical insights that could lead to updates in decision-making guidelines that have relied on data from two decades ago.

Conducted by researchers at the University of Rochester (Rochester, NY, USA), the study revealed that older adults face double or triple the risk of life-threatening complications—such as debilitating strokes or subsequent heart attacks—if they undergo elective noncardiac surgeries too soon after experiencing a heart attack. A comprehensive analysis of the Medicare database, which includes 5.2 million surgeries from 2017 to 2020 involving patients aged 67 and older, indicates that delaying surgery for three to six months after the most common type of heart attack, known as a non-ST-segment elevation myocardial infarction (NSTEMI), could be beneficial. The researchers aim to identify the “sweet spot” for safely scheduling additional surgical procedures in this high-risk group.

“The data physicians are using for patient care decisions today is outdated.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.