Individuals are at a greater risk of complications from routine surgeries soon after a heart attack. Researchers have now identified a "sweet spot" for safely scheduling surgeries in those who had a heart attack.
Identifying the optimal timing for scheduling elective surgeries after a heart attack is also crucial because delaying these procedures can often result in individuals enduring prolonged pain and other difficulties.
"Perioperative teams analyze a variety of health and lifestyle factors when we assess a patient's risk and work to optimize their outcomes. It can be frustrating for individuals who suffer from joint pain to postpone a long-awaited knee or hip replacement after surviving a heart attack," said Dr. Marjorie Gloff, a co-author of the latest study in a news release.
The study published in Jama Surgery revealed that elderly cardiac patients who had a non-ST-segment elevation myocardial infarction should wait for three to six months for routine surgeries. The researchers noted that the risk of life-threatening complications, such as another heart attack or stroke, is around two to three times higher if such patients get elective surgeries too soon.
The American College of Cardiology and the American Heart Association's 2014 recommendations advise heart attack patients to wait two months before undergoing elective surgeries. This guidance was established based on a study involving 500,000 patients from 1999 to 2004.
However, researchers from the recent study propose that these recommendations should be revised based on new findings. "The data physicians are using for patient care decisions today is outdated.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 Dr. Laurent Glance, lead author of the study, in a news release.
The current study used insurance data covering 5.2 million major non-cardiac surgeries performed between 2017 and 2020 on patients aged 67 and older. Among the patients analyzed in the study, over 42,000 had experienced a heart attack before their surgery.
The researchers observed that the majority of deaths and significant complications typically occur within the first 30 days following surgery. Interestingly, they also found that the risk of such adverse events decreases during the first 90 days of recovery. After this initial period, the risk tends to stabilize and remain consistent for the subsequent 180 days.
"Delaying elective noncardiac surgery to occur between 90 and 180 days after an NSTEMI may be reasonable for patients who have had revascularization," the researchers concluded.
