title: The influence of surgery on the onset of symptomatic coronary artery disease.
abstract: We speculated that asymptomatic patients undergoing routine surgery might be at higher risk of subsequent cardiac events. We studied 183,534 patients with no prior admission for heart disease, aged 50-75 years, admitted electively for one of five operations considered medium to low risk of peri-operative cardiac morbidity, between January 1997 and December 2005. Controls were generated from linked records. Within 3 years 3444 (1.9%) patients undergoing operations had subsequent myocardial infarction/acute coronary syndrome (MI/ACS) compared with 3708 (2.0%) controls (p < 0.001). Overall 8406 (4.6%) patients undergoing surgery had MI/ACS compared with 9306 (5.1%) controls (p < 0.001). Of patients undergoing surgery, 20.2% died compared with 25.7% of controls (p < 0.001). Patients undergoing certain surgical procedures did not have a higher incidence of readmission for cardiac events, but had a general survival benefit compared with other elective hospital admissions. Assessment for surgery may represent a health benefit beyond the original surgery.
authors.affiliation: Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK. harry.mcfarlane@nhs.net
authors.forename: H J
authors.initials: HJ
authors.lastname: McFarlane
authors.forename: L
authors.initials: L
authors.lastname: Girdwood
authors.forename: A
authors.initials: A
authors.lastname: Bhaskar
authors.forename: D
authors.initials: D
authors.lastname: Clark
authors.forename: N R
authors.initials: NR
authors.lastname: Webster
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000009:adverse effects