Biomedical subjects
Sarah K Thompson
Publications and source records attributed to Sarah K Thompson.
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.
Perioperative stroke occurring in patients who undergo neck dissection for head and neck cancer: unanswered questions.
Stroke represents a major cause of disability among middle-aged and elderly people. Carotid artery stenosis is an important risk factor for stroke and is prevalent in elderly men with hypertension, diabetes mellitus, and those who smoke or have atherosclerotic disease, or both. Patients who undergo neck dissection for head and neck cancer may have some or all of the above characteristics and may experience surgical manipulation of the carotid arteries. This combination of medical and surgical factors may predispose such patients to perioperative stroke. A critical review of the literature was completed to determine the incidence of stroke perioperatively in patients undergoing a neck dissection for head and neck cancer. We found 2 studies that quoted the risk of stroke to be between 3.2% and 4.8%. The implications of these results are significant because they suggest a need for preoperative screening (with Doppler ultrasonography) or intervention (with carotid endarterectomy), or both. However, the quality of these 2 studies is such that future research is first needed to define the rate of stroke in head and neck surgery.
Soft-tissue case 43. Cecal volvulus: differentiating distended viscus from pneumoperitoneum.
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