Delaying elective procedures by three to six months reduces complications for older adults.
Research from the University of Rochester, published recently in JAMA Surgery, has highlighted the significance of timing.
Following a heart attack, older adults face a two to three times higher risk of severe complications, such as stroke or recurrent myocardial infarction, if elective non-cardiac surgeries proceed too soon.
Researchers aim to identify the ‘sweet spot’ for safely scheduling additional surgical procedures in this high-risk population.
The study provides valuable analysis to support changes to decision-making guidelines based on data that is now 20 years old.
The study analysed Medicare data from 5.2 million surgeries (2017-2020) for patients ≥ over 67 years old and found that delaying elective surgery for 3-6 months post-NSTEMI significantly reduces risks.
This study updates 20-year-old guidelines, aiming to refine perioperative planning.
Laurent Glance, lead author and professor at URMC, said: ‘The data physicians use’ for patient care decisions today is outdated. Given the advances in care and the ever-changing mix of patients, clinicians need the latest information.’
Based on data from 1999-2004, current guidelines recommend a 60-day delay post-MI. Yet this analysis reveals that risk peaks within 30 days, decreases over 90 days, and stabilises by six months.
Ageing patients with comorbidities present unique perioperative challenges, requiring careful risk-benefit assessments.
Marjorie Gloff, co-author and director of URMC’s Centre for Perioperative Medicine, said. ‘Balancing surgical risks and quality of life is crucial. Delaying procedures like joint replacements can be frustrating but is often necessary post-MI.’
Co-authors include Heather Lander, MD, Stewart Lustik, MD, Michael Eaton, MD, Sabu Thomas, MD (URMC); Mark Sorbero, MS, Andrew Dick, PhD (RAND Health); Karen E. Joynt Maddox, MD (Washington University); Lee Fleisher, MD (UPenn); Jingjing Shang, PhD, RN, and Patricia Strong, PhD, RN (Columbia).
