Post-Heart Attack Surgery: Delaying Elective Procedures Can Reduce Risks for Older Adults

New research from the University of Rochester highlights the increased risks that aging adults face when undergoing elective noncardiac surgeries too soon after a heart attack. Published in *JAMA Surgery*, the study indicates that individuals aged 67 and older may experience double or even triple the risk of life-threatening complications, such as a debilitating stroke or another heart attack, if they proceed with surgery too quickly following a non-ST-segment elevation myocardial infarction (NSTEMI).

The research analyzed data from the Medicare database, covering 5.2 million surgeries performed between 2017 and 2020. The findings suggest that waiting three to six months after an NSTEMI before scheduling additional surgical procedures can significantly lower the associated risks. This study aims to identify the optimal timing, or the "sweet spot," for safely conducting surgeries in this vulnerable population, offering insights to potentially update decision-making guidelines that have remained unchanged for over two decades.

Dr. Laurent Glance, the lead author and a professor of Anesthesiology and Perioperative Medicine and Public Health Sciences at the University of Rochester Medical Center (URMC), emphasized the importance of current data for patient care decisions: "The data physicians are using for patient care decisions today is outdated.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."

The existing American College of Cardiology and American Heart Association guidelines recommend waiting 60 days after a heart attack before undergoing elective noncardiac surgery. These guidelines were based on an analysis of 500,000 patients between 1999 and 2004. However, this new analysis reveals a decline in risk during the first 90 days following a heart attack, after which the risk levels off for the next 180 days.

For aging patients who often present with multiple acute or chronic conditions, physicians face the challenge of balancing the risks of surgical procedures with patients' expectations for quality of life. Dr. Marjorie Gloff, a co-author and director of URMC's Center for Perioperative Medicine, noted the difficulties that arise: "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 with joint pain to postpone a long-awaited knee or hip replacement after surviving a heart attack."

The research team also included 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 Columbia School of Nursing. This vital study was supported by funding from the National Institute of Aging, National Institute of Nursing Research, and URMC's Department of Anesthesiology and Perioperative Medicine.