title: Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis.
abstract: OBJECTIVE
  To determine the incidence of perioperative stroke in patients undergoing a neck dissection.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Surgery, the Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Thompson
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Southern
authors.forename: J Gregory
authors.initials: JG
authors.lastname: McKinnon
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*