Risk of surgery following recent myocardial infarction.

Abstract

OBJECTIVE:

We aimed to assess the impact of recent myocardial infarction (MI) on outcomes after subsequent surgery in the contemporary clinical setting.

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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%, and 91-180 days = 5.9%), as did 30-day mortality (0-30 days = 14.2%, 31-60 days = 11.5%, 61-90 days = 10.5%, and 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).

CONCLUSIONS:

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.

• Authors: Masha Livhits, Clifford Y Ko, Michael J Leonardi, David S Zingmond, Melinda Maggard Gibbons, Christian de Virgilio
• Journal: Annals of surgery (Ann Surg) Vol. 253 Issue 5 Pg. 857-64 (May 2011) ISSN: 1528-1140 [Electronic] United States
• PMID: 21372685 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: (C) 2011 Lippincott Williams & Wilkins, Inc.

Topics

• Adult
• Age Distribution
• Aged
• California
• Cause of Death
• Chi-Square Distribution
• Cohort Studies
• Coronary Disease (diagnosis, mortality, surgery)
• Databases, Factual
• Female
• Hospital Mortality (trends)
• Humans
• Incidence
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (diagnostic imaging, mortality, surgery)
• Postoperative Complications (mortality)
• Proportional Hazards Models
• Radiography
• Recurrence
• Reference Values
• Risk Assessment
• Sex Distribution
• Surgical Procedures, Operative (methods, mortality)
• Survival Analysis
• Time Factors