title: Postoperative myocardial injury after major head and neck cancer surgery.
abstract: BACKGROUND
  Patients with head and neck cancer often have multiple risk factors for coronary artery disease. Yet, little is known about the incidence of postoperative myocardial injury after major head and neck cancer surgery and its clinical relevance. The aim of this study was to determine the risk of postoperative myocardial injury in patients undergoing major head and neck cancer surgery.
  
  
  METHODS
  This was a retrospective cohort study of all patients who underwent major head and neck cancer surgery (n = 378) at a single major academic center from April 2003 to July 2008. Peak postoperative troponin I (TnI) concentration was the primary outcome.
  
  
  RESULTS
  Of 378 patients who underwent major head and neck cancer surgery, 57 patients (15%) had development of an elevated TnI; 90% of these occurred within the first 24 hours after surgery. Preexisting renal insufficiency (unadjusted OR [OR]: 4.60; 95% CI 1.53-13.82), coronary artery disease (OR: 2.33; 95% CI 1.21-4.50), peripheral vascular disease (OR: 2.83; 95% CI 1.31-6.14), hypertension (OR: 2.22; 95% CI 1.20-4.12), and previous combined chemotherapy and radiation (OR: 2.68; 95% CI 1.04-6.91) were associated with elevated postoperative TnI levels. Patients with elevated TnI levels had a significantly longer length of stay in the hospital (8.5 vs 10.1 days; p = .014) and ICU (3 vs 4.5 days; p = .001) and an 8-fold increased risk of death at 60 days after surgery (adjusted OR: 8.01, 95% CI 2.03-31.56). At 1 year, patients with an abnormal postoperative TnI level were twice as likely to die (OR 1.93; 95% CI 1.02-3.63).
  
  
  CONCLUSIONS
  Patients who undergo major head and neck cancer surgery are at significant risk for postoperative myocardial injury, which is a strong predictor of 60-day mortality after surgery. Monitoring of myocardial injury during the first postoperative days, as well as optimizing preventive cardiac care, may be helpful to reduce postoperative mortality rates.
authors.affiliation: Department of Anesthesiology, Washington University, St. Louis, MO 63110, USA. nagelep@wustl.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Nagele
authors.forename: Lesley K
authors.initials: LK
authors.lastname: Rao
authors.forename: Mrudula
authors.initials: M
authors.lastname: Penta
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
authors.forename: Edward L
authors.initials: EL
authors.lastname: Spitznagel
authors.forename: Laura F
authors.initials: LF
authors.lastname: Cavallone
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I