A Population-Based Study of 30-day Incidence of Ischemic Stroke Following Surgical Neck Dissection.
The objective of this study was to determine the 30-day incidence of ischemic stroke following neck dissection compared to matched patients undergoing non-head and neck surgeries.A surgical dissection of the neck is a common procedure performed for many types of cancer. Whether such dissections increase the risk of ischemic stroke is uncertain.A retrospective cohort study using data from linked administrative and registry databases (1995-2012) in the province of Ontario, Canada was performed. Patients were matched 1-to-1 on age, sex, date of surgery, and comorbidities to patients undergoing non-head and neck surgeries. The primary outcome was ischemic stroke assessed in hospitalized patients using validated database codes.A total of 14,837 patients underwent surgical neck dissection. The 30-day incidence of ischemic stroke following the dissection was 0.7%. This incidence decreased in recent years (1.1% in 1995 to 2000; 0.8% in 2001 to 2006; 0.3% in 2007 to 2012; P for trend <0.0001). The 30-day incidence of ischemic stroke in patients undergoing neck dissection is similar to matched patients undergoing thoracic surgery (0.5%, P = 0.26) and colectomy (0.5%, P = 0.1). Factors independently associated with a higher risk of stroke in 30 days following neck dissection surgery were of age ≥75 years (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.05-2.53), and a history of diabetes (OR 1.60, 95% CI 1.02-2.49), hypertension (OR 2.64, 95% CI 1.64-4.25), or prior stroke (OR 4.06, 95% CI 2.29-7.18).Less than 1% of patients undergoing surgical neck dissection will experience an ischemic stroke in the following 30 days. This incidence of stroke is similar to thoracic surgery and colectomy.
Department of Otolaryngology-Head and Neck Surgery, Western University, London (SDM, ST, JY, AN, KF); Institute for Clinical and Evaluative Sciences (SDM, KL, AXG, AT, SH, SZS); Department of Epidemiology and Biostatistics, Western University (AXG, AT); Department of Family Medicine, Western University (AT); Department of Oncology, Western University, London (SDM, DP, EW, JY, AN, KF); Department of Otolaryngology-Head and Neck Surgery, Cancer Care and Epidemiology, Queens University, Kingston (SH); Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada (AXG).
S Danielle
SD
MacNeil
Kuan
K
Liu
Amit X
AX
Garg
Samantha
S
Tam
David
D
Palma
Amardeep
A
Thind
Eric
E
Winquist
John
J
Yoo
Anthony
A
Nichols
Kevin
K
Fung
Stephen
S
Hall
Salimah Z
SZ
Shariff
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology; D002170:Canada / Q000453:epidemiology; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects* / Q000379:methods; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods