New findings indicate that senior individuals should ideally wait between three to six months after experiencing a heart attack before undergoing any elective noncardiac surgery. This interval helps lower the chances of severe complications, such as a stroke or another heart attack.
According to recent research from the University of Rochester, older adults who have had a heart attack are at a significantly increased risk—up to three times greater—for serious complications like strokes or subsequent heart attacks if they proceed with elective noncardiac surgeries too soon.
An extensive review of Medicare data, covering 5.2 million surgeries performed from 2017 to 2020 on patients aged 67 and older, advocates for postponing elective procedures for three to six months following a non-ST-segment elevation myocardial infarction (NSTEMI), a common type of heart attack.
The study aims to pinpoint the optimal timeframe for scheduling additional surgeries for this vulnerable group. The findings offer important insights that could lead to updates in the surgical decision-making guidelines that have remained unchanged for over two decades.
“The evidence healthcare providers rely on today is outdated. With advancements in treatment and changes in patient demographics, clinicians require current data,” stated Laurent Glance, MD, the lead researcher and professor of Anesthesiology and Perioperative Medicine and Public Health Sciences at the University of Rochester Medical Center (URMC).
The guidelines established in 2014 by the American College of Cardiology and the American Heart Association recommend waiting 60 days after a heart attack before elective noncardiac surgery, based on a study of 500,000 patients from 1999 to 2004.
Most post-surgery fatalities or major complications tend to occur within the first 30 days after the procedure, and perioperative teams are committed to minimizing these risks. The latest findings reveal a reduction in risk during the initial 90 days post-heart attack, stabilizing for the following 180 days.
Older patients often present with numerous acute or chronic health problems, placing physicians in the difficult position of balancing surgical safety against patients’ desires for improved quality of life.
“Our perioperative teams evaluate various health and lifestyle aspects to determine a patient’s risk and aim to enhance their results,” explained Marjorie Gloff, MD, co-author and director of URMC’s Center for Perioperative Medicine. “It can be disheartening for those dealing with joint issues to have to delay a long-anticipated knee or hip replacement after a heart attack.”
Other co-authors of this research include Gloff, Heather Lander, MD, Stewart Lustik, MD, Michael Eaton, MD, Sabu Thomas, MD, from URMC; Mark Sorbero, MS, and Andrew Dick, PhD, from RAND Health; Karen E. Joynt Maddox, MD, MPH, from Washington University; Lee Fleisher, MD, from the University of Pennsylvania; and Jingjing Shang, PhD, RN, and Patricia Strong, PhD, RN, from the Columbia School of Nursing.
This research received financial support from the National Institute of Aging, the National Institute of Nursing Research, and the Department of Anesthesiology and Perioperative Medicine at URMC.
