BACKGROUND Delaying surgery after a major cardiovascular event might reduce adverse postoperative outcomes. The time interval represents a potentially modifiable risk factor but is not well studied. METHODS This was a longitudinal retrospective population-based cohort study, linking data from Hospital Episode Statistics for NHS England and the Myocardial Ischaemia National Audit Project. Adults undergoing noncardiac, non-neurologic surgery in 2007-2018 were included. The time interval between a preoperative cardiovascular event and surgery was the main exposure. The outcomes of interest were acute coronary syndrome (ACS), acute myocardial infarction (AMI), cerebrovascular accident (CVA) within 1 year of surgery, unplanned readmission (at 30 days and 1 year), and prolonged length of stay. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios (aORs; age, sex, socioeconomic deprivation, and comorbidities). RESULTS In total, 877 430 people had a previous cardiovascular event and 20 582 717 were without an event. CVA, ACS, and AMI in the year after elective surgery were more frequent after prior cardiovascular events (adjusted hazard ratio 2.12, 95% confidence interval [CI] 2.08-2.16). Prolonged hospital stay (aOR 1.36, 95% CI 1.35-1.38) and 30-day (aOR 1.28, 95% CI 1.25-1.30) and 1-yr (aOR 1.60, 95% CI 1.58-1.62) unplanned readmission were more common after major operations in those with a prior cardiovascular event. After adjusting for the time interval between preoperative events until surgery, elective operations within 37 months were associated with an increased risk of postoperative ACS or AMI. The risk of postoperative stroke plateaued after a 20-month interval until surgery, irrespective of surgical urgency. CONCLUSIONS These observational data suggest increased adverse outcomes after a recent cardiovascular event can occur for up to 37 months after a major cardiovascular event.

中文翻译：

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脑血管意外或急性冠脉综合征术后不良结局：一项回顾性观察队列研究。


背景 在重大心血管事件后推迟手术可能会减少不良的术后结局。时间间隔代表一个潜在的可改变的危险因素，但尚未得到很好的研究。方法 这是一项纵向回顾性、基于人群的队列研究，将英格兰 NHS 医院事件统计和心肌缺血国家审计项目的数据联系起来。纳入 2007-2018 年接受非心脏、非神经手术的成人。术前心血管事件和手术之间的时间间隔是主要暴露。感兴趣的结局是急性冠脉综合征 （ACS） 、急性心肌梗死 （AMI）、手术后 1 年内的脑血管意外 （CVA）、计划外再入院 （30 天和 1 年） 和住院时间延长。使用具有受限三次样条的多变量 logistic 回归模型来估计调整后的比值比 （aORs;年龄、性别、社会经济剥夺和合并症）。结果 总共有 877 430 人既往有心血管事件，20 582 717 人没有事件。在既往心血管事件后，择期手术后一年的 CVA 、 ACS 和 AMI 更常见 （校正风险比 2.12,95% 置信区间 [CI] 2.08-2.16）。在既往有心血管事件的患者中，大手术后计划外再入院时间延长 （aOR 1.36,95% CI 1.35-1.38） 和 30 天 （aOR 1.28,95% CI 1.25-1.30） 和 1 年 （aOR 1.60,95% CI 1.58-1.62） 计划外再入院更常见。在调整了术前事件至手术之间的时间间隔后，37 个月内的择期手术与术后 ACS 或 AMI 风险增加相关。术后卒中的风险在间隔 20 个月后趋于稳定，直到手术，无论手术紧急程度如何。 结论 这些观察数据表明，在重大心血管事件发生后长达 37 个月内，近期心血管事件后的不良结局可能会增加。