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Risk Factors for Postoperative Retropharyngeal Hematoma After Anterior Cervical Spine Surgery

O'Neill, Kevin R. MD, MS; Neuman, Brian MD; Peters, Colleen MA; Riew, K. Daniel MD

Spine:
doi: 10.1097/BRS.0000000000000139
Cervical Spine
Abstract

Study Design. Retrospective review of prospective database.

Objective. To investigate risk factors involved in the development of anterior cervical hematomas and determine any impact on patient outcomes.

Summary of Background Data. Postoperative (PO) hematomas after anterior cervical spine surgery require urgent recognition and treatment to avoid catastrophic patient morbidity or death. Current studies of PO hematomas are limited.

Methods. Cervical spine surgical procedures performed on adults by the senior author at a single academic institution from 1995 to 2012 were evaluated. Demographic data, surgical history, operative data, complications, and neck disability index (NDI) scores were recorded prospectively. Cases complicated by PO hematoma were reviewed, and time until hematoma development and surgical evacuation were determined. Patients who developed a hematoma (HT group) were compared with those that did not (no-HT group) to identify risk factors. NDI outcomes were compared at early (<11 mo) and late (>11 mo) time points.

Results. There were 2375 anterior cervical spine surgical procedures performed with 17 occurrences (0.7%) of PO hematoma. In 11 patients (65%) the hematoma occurred within 24 hours PO, whereas 6 patients (35%) presented at an average of 6 days postoperatively. All underwent hematoma evacuation, with 2 patients (12%) requiring emergent cricothyroidotomy. Risk factors for hematoma were found to be (1) the presence of diffuse idiopathic skeletal hyperostosis (relative risk = 13.2, 95% confidence interval = 3.2–54.4), (2) presence of ossification of the posterior longitudinal ligament (relative risk = 6.8, 95% confidence interval = 2.3–20.6), (3) therapeutic heparin use (relative risk 148.8, 95% confidence interval = 91.3–242.5), (4) longer operative time, and (5) greater number of surgical levels. The occurrence of a PO hematoma was not found to have a significant impact on either early (HT: 30, no-HT: 28; P = 0.86) or late average NDI scores (HT: 28, no-HT 31; P = 0.76).

Conclusion. With fast recognition and treatment, no long-term detriment from PO anterior cervical hematoma was found. We identified risk factors to be (1) presence of diffuse idiopathic skeletal hyperostosis, (2) presence of ossification of the posterior longitudinal ligament, (3) therapeutic heparin use, (4) longer operative time, and (5) greater number of surgical levels.

Level of Evidence: 4

In Brief

A review of 2375 anterior cervical surgical procedures revealed 17 occurrences (0.7%) of postoperative (PO) hematoma. Identified risk factors were (1) diffuse idiopathic skeletal hyperostosis, (2) ossification of the posterior longitudinal ligament, (3) therapeutic heparin use, (4) longer operative time, and (5) greater number of surgical levels. When appropriately treated, the occurrence of a PO hematoma was not found to impact neck disability index outcome scores.

Author Information

From the Cervical Spine Service, Washington University, Department of Orthopedics, St. Louis, MO.

Address correspondence and reprint requests to K. Daniel Riew, MD, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO 63110. Email: riewd@wudosis.wustl.edu.

Acknowledgment date: September 3, 2013. First revision date: October 30, 2013. Acceptance date: November 4, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, expert testimony, grants/grants pending, royalties, stock/stock options and travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins