Perioperative cardiovascular outcomes among older adults undergoing in-hospital noncardiac surgery

Document Type

Journal Article

Publication Date



Journal of the American Geriatrics Society




mortality; myocardial infarction; noncardiac; older adults; operative; outcomes; stroke


Background: Older adults undergoing noncardiac surgery have a high risk of major adverse cardiovascular events (MACE). This study aims to estimate the magnitude of increased perioperative risk, and examine national trends in perioperative MACE following in-hospital noncardiac surgery in older adults compared to middle-aged adults. Design: Time-series analysis of retrospective longitudinal data. Setting: The United States Agency for Healthcare Research and Quality National Inpatient Sample (NIS). Participants: Hospitalizations for major noncardiac surgery among adults age ≥45 years between January 2004 and December 2014. Measurements: Inpatient perioperative MACE was defined as a composite of in-hospital death, myocardial infarction (MI), and ischemic stroke. In hospital death was determined from the NIS discharge disposition. MI and ischemic stroke were defined by International Classification of Diseases, Ninth Revision codes. Results: Of an estimated 55,349,978 surgical hospitalizations, 26,423,039 (47.7%) were for adults age 45–64, 14,231,386 (25.7%) age 65–74, 10,621,029 (19.2%) age 75–84 years, and 4,074,523 (7.4%) age ≥85 years. MACE occurred in 1,601,022 surgical hospitalizations (2.9%). Adults 65–74 (2.8%; aOR 1.16, 95% CI 1.14–1.17), 75–84 years (4.5%; aOR 1.30, 95% CI 1.28–1.32), and ≥85 years (6.9%; aOR 1.55, 95% CI 1.52–1.57) had greater risk of MACE than those 45–64 years (1.7%). From 2004 to 2014, MACE declined among adults 65–74 (3.1–2.5%, p < 0.001), 75–85 years (4.9–3.9%, p < 0.001), and ≥85 years (7.7–6.1%, p < 0.001), but was unchanged for adults age 45–64. Declines in MACE were driven by decreased MI and mortality despite increased stroke. Conclusion: Older adults accounted for half of hospitalizations, but experienced the majority of MACE. Older adults had greater adjusted odds of MACE than younger individuals. The proportion of perioperative MACE declined over time, despite increases in ischemic stroke. These data highlight risks of noncardiac surgery in older adults that warrant increased attention to improve perioperative outcomes.