Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis.
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.
Thompson
Sarah K
SK
Department of Surgery, the Centre for Health and Policy Studies, University of Calgary, Calgary, Alberta, Canada.
Southern
Danielle A
DA
McKinnon
J Gregory
JG
Dort
Joseph C
JC
Ghali
William A
WA
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*