Postoperative myocardial injury after major head and neck cancer surgery

Peter Nagele, Lesley K. Rao, Mrudula Penta, Dorina Kallogjeri, Edward L. Spitznagel, Laura F. Cavallone, Brian Nussenbaum, Jay F. Piccirillo

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

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). Conclusion:s. 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.

Original languageEnglish
Pages (from-to)1085-1091
Number of pages7
JournalHead and Neck
Volume33
Issue number8
DOIs
StatePublished - Aug 2011

Keywords

  • Myocardial infarction
  • Outcomes
  • Troponin

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