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Shorter Wait for Surgery After Stents OK, Surgeon Says

Cheryl Clark, for HealthLeaders Media, October 9, 2013

Requiring patients with drug-eluting stents to wait a year before they can undergo elective surgery "is a common problem" for surgeons. But a large-scale study indicates the risk of adverse events such as serious blood clots may be overblown.

To avoid major adverse events like thrombosis, surgeons require patients implanted with drug-eluting stents (DES) to wait at least one year before they may safely undergo elective surgeries.

But a large-scale study indicates the risk of adverse events such as serious blood clots may be overblown and half of that wait may be unnecessary. The report suggests that patients need only wait six months, with no more risk than patients implanted with bare metal stents (BMS).

"Our study, in combination with several other large population-based studies published in the last several years, will probably prompt cardiology societies to revisit their guidelines and clarify when it may be safe to operate on a patient with DES, and under what conditions," says Mary Hawn, MD, of the Department of Surgery at the University of Alabama at Birmingham, the study's corresponding author.

"What we found is that there's really no difference in outcomes based on stent type."

Hawn and fellow researchers can't say definitively how many patients might benefit from earlier surgery, but she notes that requiring patients to wait before they can undergo needed but non-urgent surgeries "is a common problem for us [surgeons]. I do think that there are many patients I see in my own practice who are upset by the delay, because they have symptoms they want to have treated."

Additionally, surgery to relieve pain may prompt patients to move more, which may reduce their heart disease risks.

Hawn's report, based on a sample of 41,989 stent procedures between 2000 and 2010, and which tracked surgery related events for two years, was published online Monday in the Journal of the American Medical Association.

The study is important because more than 600,000 procedures a year involve the placement of one or more stents, and often patients require subsequent surgery for unrelated medical conditions. About 60% to 70% of those stents are DES.

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