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Ischemic stroke following neck dissection in the elderly

Chuan‑Yi Kuoa†, Yi‑Ting Chenb†, Cheuk‑Kwan Sunc, Kuo‑Chuan Hungd*


aDepartment of Anesthesiology, E‑Da Hospital and I‑Shou University, Kaohsiung, Taiwan, bDepartment of Anesthesiology, Chang Gung Memorial Hospital, Chiayi, Taiwan, cDepartment of Emergency Medicine, E‑Da Hospital and I‑Shou University, Kaohsiung, Taiwan, dDepartment of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
†Both authors contributed equally to this work.

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

Objective: Despite the known association of perioperative stroke with perioperative mortality, the prevalence of stroke following neck dissection in elderly patients remains unclear. This study compared the incidence of neck dissection‑associated perioperative stroke in elderly and younger patients. Materials and Methods: Totally, 1057 patients receiving neck dissection for head and neck cancers between June 2012 and July 2016 were reviewed at a single center. The patients were divided into elderly (age ≥65 years, n = 177) and younger (age <65 years, n = 880) groups (mean age: 72.3 ± 6.1 and 53.3 ± 7.6, respectively). Patient, anthropometric, and clinical characteristics including diagnoses, comorbidities, length of hospitalization, and incidence of perioperative stroke were compared. Results: Younger patients were more likely to be male (P = 0.001) and to have received radiotherapy (P = 0.013). The prevalence
of predisposing factors was higher in the elderly, including history of cerebral vascular accident (P = 0.002), hypertension (P < 0.001), diabetes (P < 0.001), and coronary artery disease (P < 0.001). Elderly patients also had longer hospitalizations (P < 0.001) for which
previous radiotherapy was identified as a risk factor (adjusted odds ratio = 3.79, P = 0.0078). Postoperative ischemic stroke was diagnosed in two elderly patients (1.1%), whereas no ischemic strokes occurred in the younger group (P = 0.028). The overall incidence of perioperative stroke was 0.19%. Conclusion: The incidence of perioperative stroke was higher in the elderly than in the younger group. Furthermore, the prevalence of ischemic stroke in elderly patients associated with neck dissection was higher than that previously reported in the aged population after general head and neck operations, highlighting an increased risk of stroke in elderly patients receiving extensive neck surgery.
Keywords: Head and neck cancer, Neck dissection, Perioperative stroke

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