{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:45:03Z","timestamp":1790459103048,"version":"4.1.0"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec id=\"ab-ooi250016-4\"><jats:title>Importance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250016-5\"><jats:title>Objective<\/jats:title><jats:p>To determine the incidence and clinical implications of MINS in patients after major head and neck surgery.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250016-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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 35\u202f000 patients who had noncardiac surgery. Of those, 648 patients (1.8%) 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250016-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250016-8\"><jats:title>Results<\/jats:title><jats:p>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 \u03b2, 3.15 days; 95% CI, 1.47-6.76 days).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250016-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2025.0656","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T11:31:04Z","timestamp":1745494264000},"page":"647","source":"Crossref","is-referenced-by-count":4,"title":["Myocardial Injury After Major Head and Neck Surgery"],"prefix":"10.1001","volume":"151","author":[{"given":"Phillip","family":"Staibano","sequence":"first","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit X.","family":"Garg","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Western University, London, Ontario, Canada"},{"name":"Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada"},{"name":"Lawson Health Research Institute, London Health Sciences Centre, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T. 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