Incidence of Perioperative Stroke after Neck Dissection for Head and Neck Cancer: A Regional Outcome Analysis

Objective: To determine the incidence of perioperative stroke in patients undergoing a neck dissection. Summary Background Data: The incidence of perioperative stroke in non-head and neck surgery is between 0.08 and 0.2%. In contrast, a critical review of the literature identified 2 studies stating the incidence of perioperative stroke in head and neck surgery to be 3.2% and 4.8%. The implications of these results are significant because they suggest a potential need for preoperative screening and/or intervention for carotid artery pathology. Methods: This historical cohort study was conducted using discharge data for all neck dissections performed in a geographically-defined health region in Alberta, Canada, from 1994 to 2002. Subjects were selected for study if they had an assigned ICD-9CM procedure code for a neck dissection at one of the region's 3 adult-care hospitals. Our main outcome measure was perioperative stroke. Results: Patients (n = 499) were identified as having had a neck dissection (mean age 56.5 ± 15.3 SD, 65.3% male). Seven patients had ICD-9CM codes for postoperative central nervous system complications (incidence of 1.4%). However, on chart review, only one had had a true perioperative stroke corresponding to an incidence of 0.2% (95% confidence interval 0.01, 1.12). No missed strokes were found in a confirmatory random review of 10% of charts. Conclusions: The incidence of perioperative stroke in this study is significantly lower than that previously stated in the literature. This suggests that preoperative screening and/or intervention for carotid artery disease may not be necessary in this patient population.