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• Posted November 1, 2024

When Is It OK to Undergo Routine Surgery After a Heart Attack?

Seniors who’ve had a heart attack should probably delay any elective surgeries for three to six months, a new study advises.

People aged 67 and older face double to triple the risk of life-threatening complications -- like a stroke or a second heart attack -- if they move forward with elective surgery too soon following a heart attack, researchers found.

The new study shows that current guidelines likely are too loose, the study authors noted.

Currently, heart attack patients are told to wait two months before undergoing any elective surgery, researchers said in background notes.

But those guidelines are based on data more than 20 years old, from a study of 500,000 patients conducted between 1999 and 2004, researchers said.

“The data physicians are using for patient care decisions today is outdated,” said lead researcher Dr. Laurent Glance, a professor of anesthesiology and perioperative medicine and public health sciences at the University of Rochester Medical Center (URMC). “Given the advances in care and the ever-changing mix of patients, clinicians need the latest information.”

For the new study, researchers analyzed Medicare claims data between 2015 and 2020 for 5.2 million major non-cardiac surgeries involving patients 67 and older.

Of those patients, more than 42,000 had experienced a heart attack prior to their surgery.

The risk is highest when a patient has elective surgery within 30 days of a heart attack. These patients are nearly three times more likely to die of any cause, and more than twice as likely to suffer a stroke or follow-up heart attack, results show.

The risk then declines after 60 days for elective surgeries and 90 days for non-elective surgeries, leveling off at 180 days, researchers reported Oct. 30 in the journal JAMA Surgery.

“Delaying elective non-cardiac surgery to occur between 90 and 180 days after [a heart attack] may be reasonable for patients who have had revascularization,” an emergency procedure during a heart attack to reopen clogged arteries, the research team concluded in a university news release.

Aging patients often face multiple health problems, and doctors must balance their risk of surgery against the improved quality of life that surgery might bring, researchers noted.

“Perioperative teams analyze a variety of health and lifestyle factors when we assess a patient’s risk and work to optimize their outcomes,” said researcher Dr. Marjorie Gloff, 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.”

More information

The American Heart Association has more about heart attacks.

SOURCE: University of Rochester Medical Center, news release, Oct. 30, 2024