Ophthalmic procedures do not increase heart attack risk, study finds
The Scandinavian study supports recommendations that for average-risk patients undergoing most types of outpatient eye surgery, preoperative cardiac tests are unnecessary.
Outpatient ophthalmological procedures do not increase the risk of acute myocardial infarction (AMI), a study found.
To estimate the relative risk for an AMI the week after an ophthalmologic procedure, researchers conducted a case-crossover study of 353,031 patients ages 40 years and older, identified from inpatient registries and linked to outpatient surgical procedures in Norway and Sweden. Researchers assessed ophthalmologic procedures 0 to 7 days before an AMI (hazard period) compared with days 29 to 36 before AMI (control period). Results were published by Annals of Internal Medicine on March 22.
Overall, 806 patients had an AMI in the studied timeframes: 344 in the hazard period and 462 in the control period. There was a lower likelihood of AMI in the week after an ophthalmologic procedure than during the control week (odds ratio, 0.83; 95% CI, 0.75 to 0.91). There was no evidence of increased risk for AMI when researchers stratified results by surgery subtype, anesthesia (local or general), duration, invasiveness (low, intermediate, or high), age (<65 years or ≥65 years), or comorbidity (none vs. any).
An accompanying editorial noted that medical testing and consultations are increasingly common before such surgeries despite evidence that ophthalmological procedures have low risk of complications.
The delay these tests cause may increase the risk of adverse impacts, including falls, for older patients. Although there was a low relative risk for more invasive ophthalmologic procedures, physicians should still perform a careful evaluation before procedures that are either expected to require long general anesthesia and/or are highly invasive, the editorial advised.
“Using simple questionnaires, ophthalmologists can identify the small minority of patients who should delay surgery for acute conditions as outlined in the Society for Ambulatory Anesthesia position statement,” the editorial stated. “Burdensome preoperative testing and consultations raise costs, inconvenience patients, and delay effective treatments. The medical community has an obligation to remove barriers to allow patients to have ophthalmologic procedures.”