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Annals of Surgery:
doi: 10.1097/SLA.0b013e3182125196
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Risk of Surgery Following Recent Myocardial Infarction

Livhits, Masha MD*,†; Ko, Clifford Y. MD*,†; Leonardi, Michael J. MD*; Zingmond, David S. MD; Gibbons, Melinda Maggard MD*,†,§; de Virgilio, Christian MD¶,#

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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.

© 2011 Lippincott Williams & Wilkins, Inc.

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