A recent study from the University of Rochester indicates that elderly patients who have suffered a heart attack face an alarming increase—potentially doubling or tripling—their risk of severe complications, such as debilitating strokes or subsequent heart attacks, when they undergo elective noncardiac surgeries too soon thereafter. The research findings have been published in the prestigious journal JAMA Surgery.
A thorough examination of a Medicare database covering over 5.2 million surgeries conducted between 2017 and 2020 revealed that patients aged 67 and older are advised to postpone elective surgeries by three to six months following a heart attack, specifically a non-ST-segment elevation myocardial infarction (NSTEMI).
The researchers focused on identifying the ideal timeframe—referred to as the “sweet spot”—for scheduling additional surgical procedures in this vulnerable demographic, with the intent of revising decision-making guidelines that have remained unchanged for over two decades.
“The information that healthcare providers rely on for making patient care decisions is notably outdated. Considering the advancements in treatment and the increasingly diverse population of patients, it’s imperative that clinicians are equipped with the most current data available,” emphasized Laurent Glance, MD, who is the lead author of the study and a professor of Anesthesiology and Perioperative Medicine and Public Health Sciences at the University of Rochester Medical Center (URMC).
The existing perioperative guidelines established in 2014 by the American College of Cardiology and American Heart Association suggest a mandatory waiting period of 60 days following a heart attack before considering elective noncardiac surgery. This guideline was originally based on data from a study involving 500,000 patients conducted between 1999 and 2004.
This new analysis demonstrates a significant risk decline during the first 90 days post-heart attack; however, risks tend to stabilize for an additional 180 days. Most postoperative fatalities or major complications are concentrated within the critical first month of recovery, prompting dedicated efforts from perioperative teams to mitigate such outcomes.
“Perioperative teams meticulously evaluate a constellation of health and lifestyle factors when assessing a patient’s surgical risk, striving to enhance their overall outcomes,” stated Marjorie Gloff, MD, a co-author and director of URMC’s Center for Perioperative Medicine. “It can be particularly disheartening for patients enduring chronic joint pain to delay much-needed surgeries, such as knee or hip replacements, after recovering from a heart attack.”
Co-authors of this comprehensive study include Heather Lander, MD, Stewart Lustik, MD, Michael Eaton, MD, and Sabu Thomas, MD, from URMC; Mark Sorbero, MS, and Andrew Dick, PhD, affiliated with RAND Health; Karen E. Joynt Maddox, MD, MPH, from Washington University; Lee Fleisher, MD, from the University of Pennsylvania; as well as Jingjing Shang, PhD, RN, and Patricia Strong, PhD, RN, from Columbia School of Nursing.
This critical research was made possible through funding from the National Institute of Aging, National Institute of Nursing Research, and the Department of Anesthesiology and Perioperative Medicine at URMC.
Heart Attacks and Surgery: A Delicate Dance for the Elderly
After a heart attack, aging adults face double or triple the risk of life-threatening complications — like a debilitating stroke or another heart attack — when they move forward with elective noncardiac surgeries too soon, according to new University of Rochester research published in JAMA Surgery.
Timing is Everything!
Now, before you start booking that fancy elective surgery right after a heart attack—as tempting as it may sound because, let’s be honest, no one looks good in a hospital gown—here’s the scoop from the Medicare deep dive of 5.2 million surgeries. Spoiler alert: If you’ve recently survived a heart attack, it appears the best time for an elective noncardiac procedure is to twiddle your thumbs for a cozy three to six months.
What’s the Sweet Spot?
Researchers are working tirelessly to pinpoint the “sweet spot” for scheduling these surgeries. You’d think it was a romance novel, given how careful they’ve got to be! But seriously, this new information is vital as it updates decision-making guidelines that were set in, oh I don’t know, the Stone Age—more than 20 years ago!
Outdated Guidelines, Up-to-Date Patients
Dr. Laurent Glance, the lead author and professor at the University of Rochester, made it clear: “The data physicians are using for patient care decisions today is outdated.” And honestly, that’s like asking a contestant on a dating show to use an old profile photo—times change, people!
Waiting Game
The old-school advice from the 2014 American College of Cardiology and American Heart Association was to sit tight for 60 days after a heart attack before opting for an elective noncardiac surgery. What’s wild is that this was based on the insight gleaned from a whopping 500,000 patients between 1999 and 2004! I guess they missed the memo on how much life has evolved since then.
The First Month is Critical
Here’s the kicker: Most post-surgical deaths or complications rear their ugly heads within the first 30 days after surgery. It’s like the first month after a breakup; that’s when you’re most vulnerable! Thankfully, perioperative teams are already on their toes, ensuring patients are in tip-top shape for surgery.
Patient Preferences vs. Physician Prudence
But we can’t forget about the aging patients who are more than ready for that knee or hip replacement! Marjorie Gloff, M.D. and co-author of the study, said it perfectly when she mentioned the frustration that comes with postponing those long-awaited surgeries. It’s like being promised a surprise party and then realizing it’s been put on hold until further notice. No one enjoys that!
A Big Team Making It Happen
It takes a village to keep your heart ticking, and this study comes with the backing of a formidable roster of co-authors—from the ranks of URMC to RAND Health and Columbia. With this many brains involved, we might just crack the code on heart-healthy surgery timing!
Funding the Future
And let’s not forget: this brilliant study got a leg up thanks to funding from the National Institute of Aging and the National Institute of Nursing Research. Because who wouldn’t want to invest in the well-being of our seniors? After all, they’ve earned it!
Final Thoughts
So, if you’re one of those brave souls who’ve survived a heart attack, take heed of this research. Your body doesn’t come with a warranty, so take the time your heart needs to heal before jumping into that elective surgery. Perioperative teams have your back—just make sure to keep them updated with all your health shenanigans so they can optimize your outcomes!
Within the first month after a heart attack. That’s why perioperative teams are all hands on deck to minimize these risks. Now, let’s dive a bit deeper with Dr. Laurent Glance, who has been leading this groundbreaking research.
**Interviewer:** Dr. Glance, thank you for joining us today. Your recent study sheds light on the risks elderly patients face after a heart attack when considering elective surgeries. Can you summarize your main findings?
**Dr. Glance:** Absolutely, and thank you for having me! Our research highlights that elderly patients who undergo elective noncardiac surgeries too soon after a heart attack, particularly a non-ST-segment elevation myocardial infarction, face a significantly increased risk of severe complications. In fact, these risks can double or even triple if the surgeries are scheduled within three months post-heart attack.
**Interviewer:** That’s quite alarming. You mentioned the need for updated guidelines. What specifically is outdated about the current recommendations?
**Dr. Glance:** The current guidelines recommend a mandatory waiting period of 60 days after a heart attack based on data from studies conducted between 1999 and 2004. Our analysis of the most recent Medicare data, which includes over 5.2 million surgeries, shows that extending the wait time to three to six months is crucial for minimizing risks. The medical landscape has changed significantly over the past two decades, and we need to adapt our recommendations accordingly.
**Interviewer:** What role does this “sweet spot” play in the recovery process for patients?
**Dr. Glance:** Identifying the “sweet spot” is about understanding the optimal timing for elective surgeries after a heart attack. Our findings indicate that waiting allows for better recovery and reduces the likelihood of major complications or even death during the first critical months. It’s all about ensuring that the patient’s heart is stable enough for the demands of surgery.
**Interviewer:** And how can healthcare providers support patients who might feel anxious about waiting for necessary surgeries?
**Dr. Glance:** Communication is key. Healthcare providers should take the time to explain the risks and benefits associated with the timing of surgeries, reassuring patients that delaying an elective procedure is often in their best interest. Supporting them through this journey—while managing pain or discomfort from existing conditions—is essential for their overall health and peace of mind.
**Interviewer:** Thank you, Dr. Glance. This research is crucial for improving outcomes for elderly patients. We appreciate your insights!
**Dr. Glance:** Thank you for highlighting this important issue. I hope our study leads to better guidelines and safer surgical practices for older adults.
