Timing Elective Surgery After a Patient’s MI or Stroke

A vast analysis suggests waiting 12-18 months between cardiovascular event and major orthopaedic surgery to decrease the risk of death

What’s the Claim?

Perhaps the greatest imperative we face when recommending surgery is ensuring that the patient survives. An enormous registry study helps us do that. It found:

  • The 30-day risk of death following surgery among patients with a prior cardiovascular event — acute coronary syndrome (ACS) or stroke — was elevated if elective surgery was performed within 14 months of the cardiovascular event.
  • For major procedures where there’s otherwise a low risk of death (like hip arthroplasty), an elevated risk of death was observed if surgery was performed within 18 months of ACS or stroke.
  • Risk decreases steeply over time, but the adjusted odds of death after orthopaedic surgery remained nearly double even 12 months after a cardiovascular event.

Although this is observational research, these findings are both practical and important — about 10% of patients who had surgery within a year of a cardiovascular event died within 30 days of that surgical procedure, so these findings deserve our attention.

How’s It Stack Up?