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Head and Neck Cancer Surgery Patients at Major Risk of Developing Myocardial Ischaemia: Presented at ASA

By Lexa W. Lee

NEW ORLEANS -- October 20, 2009 -- Of patients with head and neck cancer who have undergone surgery, 15% will develop postoperative myocardial ischemia, according to a study presented here October 19 at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA).

In addition, ischaemia is a strong predictor of 60-day mortality following surgery, according to presenter Lesley Rao, MD, Washington University, St. Louis, Missouri.

For the study, researchers performed a retrospective cohort study of 378 patients who underwent major head and neck cancer surgery. Potential risk factors for postoperative myocardial ischemia, such as heart disease and smoking history, were recorded. Troponin levels were serially measured up to the fifth day after surgery.

Peak postoperative troponin I (TnI) concentration was the main outcome variable; a level over 0.1 ng/mL was considered abnormally high.

Of the 378 patients, 57 patients (15%) developed an elevated TnI; 90% of which occurred within 24 hours after surgery.

A history of renal insufficiency, coronary artery disease, peripheral vascular disease, hypertension, and combined chemotherapy and radiation were associated with elevated postoperative TnI. This group had a significantly longer length of stay in the hospital compared with those with lower TnI levels (8.5 vs 10.1 days; P = .014), ICU stay (3 vs 4.5 days; P = .001), and an 8-fold higher risk of death at 60 days following surgery (odds ratio [OR] = 7.62; 95% confidence interval [CI], 1.98-29.31). At 1 year, patients with an abnormally high postoperative TnI were twice as likely to die (OR 1.93; 95% CI, 1.02-3.63).

The researchers suggest that patients be monitored for postoperative myocardial ischaemia following major head and neck cancer surgery, and that those with elevated troponin levels be followed up preventively by a cardiologist.

[Presentation title: Postoperative Myocardial Ischemia in Major Head and Neck Cancer Surgery. Abstract A888]

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