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Ann Surg. 2004 Mar;239(3):428-31.

Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis.

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1
Department of Surgery, the Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada.

Abstract

OBJECTIVE:

To determine the incidence of perioperative stroke in patients undergoing a neck dissection.

SUMMARY BACKGROUND DATA:

The incidence of perioperative stroke in non-head and neck surgery is between 0.08 and 0.2%. In contrast, a critical review of the literature identified 2 studies stating the incidence of perioperative stroke in head and neck surgery to be 3.2% and 4.8%. The implications of these results are significant because they suggest a potential need for preoperative screening and/or intervention for carotid artery pathology.

METHODS:

This historical cohort study was conducted using discharge data for all neck dissections performed in a geographically-defined health region in Alberta, Canada, from 1994 to 2002. Subjects were selected for study if they had an assigned ICD-9CM procedure code for a neck dissection at one of the region's 3 adult-care hospitals. Our main outcome measure was perioperative stroke.

RESULTS:

Patients (n = 499) were identified as having had a neck dissection (mean age 56.5 +/- 15.3 SD, 65.3% male). Seven patients had ICD-9CM codes for postoperative central nervous system complications (incidence of 1.4%). However, on chart review, only one had had a true perioperative stroke corresponding to an incidence of 0.2% (95% confidence interval 0.01, 1.12). No missed strokes were found in a confirmatory random review of 10% of charts.

CONCLUSIONS:

The incidence of perioperative stroke in this study is significantly lower than that previously stated in the literature. This suggests that preoperative screening and/or intervention for carotid artery disease may not be necessary in this patient population.

PMID:
15075662
PMCID:
PMC1356243
[Indexed for MEDLINE]
Free PMC Article
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