Incidence and predictors of 30-day cardiovascular complications in patients undergoing head and neck cancer surgery.

Abstract

Incidence and predictors of peri-operative or post-operative cardiovascular complications in head and neck cancer surgery remain poorly elucidated. In this retrospective study, we investigated the rate and pre-operative risk factors for cardiovascular and cerebrovascular complications. This study included all patients (n=456) operated for head and neck cancer between 1999 and 2008. Patients' medical records were reviewed and the adjudication of endpoints was performed by adjudication committee. The 30-day incidence of cardiovascular and cerebrovascular complications was 7.2%. Cardiac mortality at 30days was 1.0%. Univariate predictors of MACCE (major adverse cardiac and cerebrovascular events) at the 30-day follow-up were history of myocardial infarction (OR 4.56, 95% CI 1.73-11.97, p=0.002); history of heart failure (OR 4.14, 95% CI 1.32-13.02, p=0.015); pre-existing coronary artery disease (OR 3.98, 95% CI 1.75-9.06, p=0.001); prior aspirin medication (OR 3.73, 95% CI 1.81-7.71, p<0.001); prior betablocker medication (OR 3.67, 95% CI 1.79-7.51, p<0.001); hypertension (OR 2.55, 95% CI 1.25-5.19, p=0.010); and increasing age (OR 1.08, 95% CI 1.05-1.12, p<0.001). In a multivariate model, independent predictors of MACCE were pre-existing coronary artery disease (OR 2.45, 95% CI 1.03-5.80, p=0.042) and increasing age (OR 1.08, 95% CI 1.04-1.11, p<0.001). Patients having surgery for head and neck cancer are at high (>5%) risk of developing vascular complications. Prior coronary artery disease and increasing age are independent risk factors for MACCE.