Surgery is a known generator of stress on the body. In some cases, that stress may result in myocardial infarction. Assessing this risk is the reason patients are evaluated prior to surgery. However, not all procedures are equally stressful to the body and traditionally ophthalmic surgery has been considered low risk. The European Society of Cardiology considers the cardiovascular risk of eye surgery to be less than one percent. A 2019 Cochrane review found no benefit of routine preoperative testing before cataract surgery compared to selective or no testing. The American Academy of Ophthalmology recommends against routine preoperative testing before cataract surgery, but does suggest targeted evaluation such as an EKG in someone with known heart disease. To further investigate the short-term risk of eye surgery, researchers from Norway and Sweden used national patient registries to examine whether there was an increased risk of acute myocardial infarction in the week following ophthalmic surgery.
The study protocol involved identifying acute myocardial infarction patients and then looking retrospectively to identify those who had eye surgery either within seven days prior to the myocardial infarction or during an eight-day period one month earlier. There were 353,031 patients identified with a first acute myocardial infarction, and 806 of those identified had eye surgery during one of the two weeks of interest. Most of these individuals had no relevant comorbidities. There were 344 patients who had eye surgery in the week before the myocardial infarction and 462 had eye surgery in the comparable period a month earlier. The risk of acute myocardial infarction was lower in the eight-day window following eye surgery than it was a month before the procedure (odds ratio 0.83, 95% CI 0.75-0.91). The results were consistent in analyses based on the type of eye surgery. In subgroup analyses that included length of surgery, type of anesthesia, and the presence of comorbidities, there was no group that had significantly increased risk in the eight days following eye surgery.
These results support the categorization of eye surgery as low risk. There did not appear to be an increase in risk of acute myocardial infarction in the timeframe when risk would be anticipated to be increased due to surgery. However, this retrospective observational study has some limitations. First, as patients typically have routine preoperative evaluation (whether with testing or not), those who are most at risk for complications will likely have their surgeries delayed until their medical status has been optimized. Also, it is possible that in the month after surgery, there are factors which start to increase risk, such as reduced activity due to the need to recover from surgery. Finally, most patients did not have relevant cardiovascular, pulmonary, or renal comorbidities so it is uncertain whether similar results would be seen in a population with such comorbidities. Nonetheless, these findings are reassuring and support the current recommendations that suggest little to no preoperative testing for eye surgery is needed.
For more information, see the topic Perioperative Cardiac Management for Noncardiac Surgery in DynaMed.
