Phillip Staibano, Amit X Garg, Matthew T V Chan, Carisi A Polanczyk, Gareth L Ackland, S Danielle MacNeil, Ashaka Patel, Michael Xie, Han Zhang, Michael Au, Mohit Bhandari, Sameer Parpia, Jason W Busse, Diane M Heels-Ansdell, Benjamin van der Woerd, Michael K Gupta, David L Choi, Egehan Salepci, J E Young, P J Devereaux
{"title":"重大头颈部手术后心肌损伤。","authors":"Phillip Staibano, Amit X Garg, Matthew T V Chan, Carisi A Polanczyk, Gareth L Ackland, S Danielle MacNeil, Ashaka Patel, Michael Xie, Han Zhang, Michael Au, Mohit Bhandari, Sameer Parpia, Jason W Busse, Diane M Heels-Ansdell, Benjamin van der Woerd, Michael K Gupta, David L Choi, Egehan Salepci, J E Young, P J Devereaux","doi":"10.1001/jamaoto.2025.0656","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Myocardial injury after noncardiac surgery (MINS) is associated with increased perioperative mortality; however, the incidence and prognostic impact of MINS after major head and neck surgery remains uncertain.</p><p><strong>Objective: </strong>To determine the incidence and clinical implications of MINS in patients after major head and neck surgery.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation; 2017) study, an international prospective cohort study that analyzed more than 15 000 patients who had noncardiac surgery. Of those, 648 patients (4.3%) underwent major head and neck surgery requiring at least 1-day hospital admission and screening for MINS via troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a high-sensitivity TnT (hsTnT) of 20 to 64 ng/L and absolute change more than 5 ng/L or hsTnT 65 ng/L or greater (ie, fifth-generation assay) and cardiac ischemia. When using fourth-generation assay, MINS was defined as non-hsTNT 0.04 ng/mL or greater and cardiac ischemia. Data analyses were performed from October to December 2024.</p><p><strong>Main outcomes and measures: </strong>MINS incidence and its association with 30-day mortality. All clinical outcomes were analyzed using Cox regression models and length of hospital stay (LOHS) was analyzed using multivariable linear regression.</p><p><strong>Results: </strong>Among 648 patients (265 [40.9%] female and 383 [59.1%] male; 376 [58.0%] aged 45 to 64 years), the incidence of MINS after major head and neck surgery was 11.9% (95% CI, 9.39%-14.4%), rising to 23.8% (95% CI, 15.7%-32%) among those aged 75 years or older. MINS occurred more often in patients with medical comorbidities. The proportion of MINS that would have gone undetected without TnT monitoring was 68.8% (95% CI, 57.3%-78.9%). In this cohort, 30-day and 1-year mortality were 1.9% (95% CI, 0.8%-2.9%) and 13.1% (95% CI, 10.5%-15.7%), respectively. MINS was associated with increased 30-day mortality (hazard ratio, 5.51; 95% CI, 1.75-17.36) and prolonged LOHS in patients with MINS with at least 1 ischemic feature (adjusted β, 3.15 days; 95% CI, 1.47-6.76 days).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that myocardial injury was common among patients undergoing major head and neck surgery, especially those aged 75 years or older and those with comorbidities. Nearly 70% of MINS cases go undetected without TnT monitoring, and MINS may contribute to worse 30-day postoperative mortality and prolonged LOHS. Further prospective validation is needed to evaluate the role of MINS screening in improving clinical outcomes after major head and neck surgery.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022864/pdf/","citationCount":"0","resultStr":"{\"title\":\"Myocardial Injury After Major Head and Neck Surgery.\",\"authors\":\"Phillip Staibano, Amit X Garg, Matthew T V Chan, Carisi A Polanczyk, Gareth L Ackland, S Danielle MacNeil, Ashaka Patel, Michael Xie, Han Zhang, Michael Au, Mohit Bhandari, Sameer Parpia, Jason W Busse, Diane M Heels-Ansdell, Benjamin van der Woerd, Michael K Gupta, David L Choi, Egehan Salepci, J E Young, P J Devereaux\",\"doi\":\"10.1001/jamaoto.2025.0656\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>Myocardial injury after noncardiac surgery (MINS) is associated with increased perioperative mortality; however, the incidence and prognostic impact of MINS after major head and neck surgery remains uncertain.</p><p><strong>Objective: </strong>To determine the incidence and clinical implications of MINS in patients after major head and neck surgery.</p><p><strong>Design, setting, and participants: </strong>This cohort study used data from the VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation; 2017) study, an international prospective cohort study that analyzed more than 15 000 patients who had noncardiac surgery. Of those, 648 patients (4.3%) underwent major head and neck surgery requiring at least 1-day hospital admission and screening for MINS via troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a high-sensitivity TnT (hsTnT) of 20 to 64 ng/L and absolute change more than 5 ng/L or hsTnT 65 ng/L or greater (ie, fifth-generation assay) and cardiac ischemia. When using fourth-generation assay, MINS was defined as non-hsTNT 0.04 ng/mL or greater and cardiac ischemia. Data analyses were performed from October to December 2024.</p><p><strong>Main outcomes and measures: </strong>MINS incidence and its association with 30-day mortality. All clinical outcomes were analyzed using Cox regression models and length of hospital stay (LOHS) was analyzed using multivariable linear regression.</p><p><strong>Results: </strong>Among 648 patients (265 [40.9%] female and 383 [59.1%] male; 376 [58.0%] aged 45 to 64 years), the incidence of MINS after major head and neck surgery was 11.9% (95% CI, 9.39%-14.4%), rising to 23.8% (95% CI, 15.7%-32%) among those aged 75 years or older. MINS occurred more often in patients with medical comorbidities. The proportion of MINS that would have gone undetected without TnT monitoring was 68.8% (95% CI, 57.3%-78.9%). In this cohort, 30-day and 1-year mortality were 1.9% (95% CI, 0.8%-2.9%) and 13.1% (95% CI, 10.5%-15.7%), respectively. MINS was associated with increased 30-day mortality (hazard ratio, 5.51; 95% CI, 1.75-17.36) and prolonged LOHS in patients with MINS with at least 1 ischemic feature (adjusted β, 3.15 days; 95% CI, 1.47-6.76 days).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that myocardial injury was common among patients undergoing major head and neck surgery, especially those aged 75 years or older and those with comorbidities. Nearly 70% of MINS cases go undetected without TnT monitoring, and MINS may contribute to worse 30-day postoperative mortality and prolonged LOHS. Further prospective validation is needed to evaluate the role of MINS screening in improving clinical outcomes after major head and neck surgery.</p>\",\"PeriodicalId\":14632,\"journal\":{\"name\":\"JAMA otolaryngology-- head & neck surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-04-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022864/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA otolaryngology-- head & neck surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1001/jamaoto.2025.0656\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA otolaryngology-- head & neck surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaoto.2025.0656","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
Myocardial Injury After Major Head and Neck Surgery.
Importance: Myocardial injury after noncardiac surgery (MINS) is associated with increased perioperative mortality; however, the incidence and prognostic impact of MINS after major head and neck surgery remains uncertain.
Objective: To determine the incidence and clinical implications of MINS in patients after major head and neck surgery.
Design, setting, and participants: This cohort study used data from the VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation; 2017) study, an international prospective cohort study that analyzed more than 15 000 patients who had noncardiac surgery. Of those, 648 patients (4.3%) underwent major head and neck surgery requiring at least 1-day hospital admission and screening for MINS via troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a high-sensitivity TnT (hsTnT) of 20 to 64 ng/L and absolute change more than 5 ng/L or hsTnT 65 ng/L or greater (ie, fifth-generation assay) and cardiac ischemia. When using fourth-generation assay, MINS was defined as non-hsTNT 0.04 ng/mL or greater and cardiac ischemia. Data analyses were performed from October to December 2024.
Main outcomes and measures: MINS incidence and its association with 30-day mortality. All clinical outcomes were analyzed using Cox regression models and length of hospital stay (LOHS) was analyzed using multivariable linear regression.
Results: Among 648 patients (265 [40.9%] female and 383 [59.1%] male; 376 [58.0%] aged 45 to 64 years), the incidence of MINS after major head and neck surgery was 11.9% (95% CI, 9.39%-14.4%), rising to 23.8% (95% CI, 15.7%-32%) among those aged 75 years or older. MINS occurred more often in patients with medical comorbidities. The proportion of MINS that would have gone undetected without TnT monitoring was 68.8% (95% CI, 57.3%-78.9%). In this cohort, 30-day and 1-year mortality were 1.9% (95% CI, 0.8%-2.9%) and 13.1% (95% CI, 10.5%-15.7%), respectively. MINS was associated with increased 30-day mortality (hazard ratio, 5.51; 95% CI, 1.75-17.36) and prolonged LOHS in patients with MINS with at least 1 ischemic feature (adjusted β, 3.15 days; 95% CI, 1.47-6.76 days).
Conclusions and relevance: This cohort study found that myocardial injury was common among patients undergoing major head and neck surgery, especially those aged 75 years or older and those with comorbidities. Nearly 70% of MINS cases go undetected without TnT monitoring, and MINS may contribute to worse 30-day postoperative mortality and prolonged LOHS. Further prospective validation is needed to evaluate the role of MINS screening in improving clinical outcomes after major head and neck surgery.
期刊介绍：
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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