Incidence and significance of myocardial injury after surgical treatment of head and neck cancer.
OBJECTIVE
To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies.


METHODS
Observational cohort study.


METHODS
Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury.


RESULTS
The average age at presentation was 62+/-12 years. There were 46 (71%) males and 19 (29%) females. Troponin-positive and -negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor-node-metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04-1.31; P<.02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04-1.71; P<.02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02-1.13; P<.001).


CONCLUSIONS
Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.
Nouraei
S A Reza
SA
Department of Otolaryngology, Charing Cross Hospital, London, and Department of Physiology, Development and Neuroscience, Cambridge University, UK. RN@cantab.net
Al-Yaghchi
Chadwan
C
Sandhu
Guri S
GS
Giussani
Dino A
DA
Doyle
Patrick
P
Clarke
Peter M
PM
D002097:C-Reactive Protein / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D037981:Neck Dissection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D014336:Troponin / Q000097:blood*
D014336:Troponin; D002097:C-Reactive Protein