Science, Medicine, and the Anesthesiologist

Appropriate timing of noncardiac surgery after a stroke or an acute coronary syndrome is unknown. This longitudinal, retrospective, population-based cohort study combined data from United Kingdom National Health Service Registries. Adults having National Health Service–funded noncardiac, nonneurologic surgeries from April 1, 2007, to March 31, 2018, were included. Data were analyzed (July 2021 to July 2022) to determine mortality and the interval between a previous acute coronary syndrome or stroke and surgery. There were 877,430 patients with and 20,582,717 without a prior cardiovascular event (mean ± SD age, 53.4 ± 19.4 yr; 54% female). The interval associated with increased postoperative mortality was surgery within 11.3 months (95% CI, 10.8 to 11.7) of a cardiovascular event. The risk interval was 14.2 months before elective surgery (95% CI, 13.3 to 15.3) and 7.3 months before emergency surgery (95% CI, 6.8 to 7.8). There was heterogeneity across surgical specialties. Absolute risk was greater after a stroke. Risk of 30-day mortality was higher in elective procedures with previous cardiovascular events (adjusted hazard ratio, 1.83; 95% CI, 1.78 to 1.89) and emergency surgeries (adjusted hazard ratio, 1.35; 95% CI, 1.34 to 1.37) compared to no prior cardiovascular events.

Take home message: Mortality after elective noncardiac nonneurologic surgery is increased after a cardiovascular event and does not plateau until approximately 14 months after the event.