Institutional members access full text with Ovid®

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¶,#

doi: 10.1097/SLA.0b013e3182125196
Feature

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.

We analyzed the impact of a recent myocardial infarction (MI) on outcomes after subsequent non-cardiac surgery. Patients with recent MI within 60 days of surgery have significantly higher rates of postoperative reinfarction and mortality. The risks decrease substantially with greater time elapsed from recent MI.

*Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA

Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA

Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, CA

§Department of Surgery, Olive View – UCLA, Sylmar, CA

Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA

#Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, CA

Reprints: Christian de Virgilio, MD, Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance CA 90509. E-mail: cdevirgilio@labiomed.org.

Supported by VA Department of Surgery and Robert Wood Johnson Physician Faculty Scholars program.

Disclosures: None.

© 2011 Lippincott Williams & Wilkins, Inc.