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Elective surgeries for older adults who recently experienced a heart attack may carry a significantly lower risk of complications if delayed for three to six months, according to recent research from the University of Rochester Medical Center (URMC) published in JAMA Surgery. This study pinpoints a "sweet spot" for scheduling noncardiac surgeries in patients post-heart attack, potentially challenging existing guidelines that recommend a shorter waiting period.
The study analyzed Medicare records covering 5.2 million surgeries performed between 2017 and 2020 on individuals aged 67 and older. Focusing on patients who experienced a non-ST-segment elevation myocardial infarction (NSTEMI)—the most common type of heart attack—the research aimed to determine an optimal delay period to reduce severe postoperative complications. Results revealed that adverse outcomes, including stroke and recurrent heart attacks, are most likely within the first 90 days after a heart attack. After this high-risk period, the risk decreases and plateaus, suggesting that scheduling elective procedures between three and six months post-heart attack could significantly improve safety.
This research could influence significant changes to current surgical planning guidelines for aging patients recovering from a heart attack. Current recommendations from the American College of Cardiology and the American Heart Association suggest waiting at least 60 days post-heart attack before elective surgery. However, these guidelines, based on nearly two-decade-old data, do not reflect advances in cardiovascular and perioperative care or the evolving demographics of patients. Dr. Laurent Glance, the study’s lead author, emphasized the importance of updated data, stating, “The data physicians are using for patient care decisions today is outdated.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.”
Understanding this optimal timing is especially critical for older adults who often live with multiple chronic conditions that may impact both their surgical risk and quality of life. For some, delaying surgery is a difficult choice, particularly for those hoping to address painful conditions, such as those requiring joint replacements. Perioperative teams play a crucial role in assessing each patient’s unique health profile and helping them navigate these complex decisions, balancing immediate health risks with the long-term benefits of improved mobility and pain relief.
By providing new evidence-based recommendations, this study supports clinicians in improving surgical outcomes and managing risks, ultimately advancing care for aging patients recovering from a heart attack.