Risk of surgery following
recent myocardial infarction
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90509, USA.
We aimed to assess the impact of recent myocardial infarction (MI) on outcomes after subsequent surgery in the contemporary clinical setting.
Prior work shows that a history of a recent MI is a risk factor for complications following noncardiac surgery. However, this data does not reflect current advances in clinical management.
Using the California Patient Discharge Database, we retrospectively analyzed patients undergoing hip surgery, cholecystectomy, colectomy, elective abdominal aortic aneurysm repair, and lower extremity amputation from 1999 to 2004 (n = 563,842). Postoperative 30-day MI rate, 30-day mortality, and 1-year mortality were compared for patients with and without a recent MI using univariate analyses and multivariate logistic regression. Relative risks (RR) with 95% confidence intervals were estimated using bootstrapping with 1000 repetitions.
Postoperative MI rate for the recent MI cohort decreased substantially
as the length of time from MI to operation increased:
- 0-30 days = 32.8%
- 31-60 days = 18.7%
- 61-90 days = 8.4%
- 91-180 days = 5.9%
- 0-30 days = 14.2%
- 31-60 days = 11.5%
- 61-90 days = 10.5%
- 91-180 days = 9.9%
MI within 30 days of an operation was associated with a higher risk of postoperative MI (RR range = 9.98-44.29 for the 5 procedures), 30-day mortality (RR range, 1.83-3.84), and 1-year mortality (RR range, 1.56-3.14).
A recent MI remains a significant risk factor for postoperative MI and mortality following surgery. Strategies such as delaying elective operations for at least 8 weeks and medical optimization should be considered.
(C) 2011 Lippincott Williams & Wilkins, Inc.