Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study
Objective The aim of this study was to investigate the incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery (ACSS).Design A retrospective nested case-control study.Setting A tertiary hospital in China.Participants A total of 13 523 patien...
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/4/e090547.full |
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| author | Jiao Li Jun Wang Min Li Yongzheng Han Mao Xu Xiangyang Guo Yang Tian Guangjin Zhou Mingya Wang Yinyin Qu Shenglin Wang |
| author_facet | Jiao Li Jun Wang Min Li Yongzheng Han Mao Xu Xiangyang Guo Yang Tian Guangjin Zhou Mingya Wang Yinyin Qu Shenglin Wang |
| author_sort | Jiao Li |
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| description | Objective The aim of this study was to investigate the incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery (ACSS).Design A retrospective nested case-control study.Setting A tertiary hospital in China.Participants A total of 13 523 patients within a single-centre longitudinal ACSS cohort were identified from March 2013 to February 2022. Patients with postoperative haematoma after ACSS were enrolled as the haematoma group, and others in the cohort without haematoma were randomly selected as the non-haematoma group by individually matching with the same operator, same gender, same surgery year and similar age (±5 years) at a ratio of 4:1. Subsequently, patients with haematoma were included in a subgroup for analysis.Primary outcome measures Postoperative haematoma and difficult intubation prior to haematoma evacuation.Results The incidence of postoperative haematoma out of all ACSS was 0.4% (55/13 523). A total of 275 patients were enrolled in the study, including 55 patients in the haematoma group and 220 patients in the non-haematoma group. Anterior cervical corpectomy and fusion (ACCF) (OR 2.459; 95% CI 1.302 to 4.642; p =0.006) and the maximum mean arterial pressure (MAP) during recovery (OR 1.030; 95% CI 1.003 to 1.058; p =0.028) were identified as independent risk factors for haematoma. In the subgroup analysis, 29% of patients with haematoma experienced difficult intubation, and retropharyngeal haematoma (OR 10.435; 95% CI 1.249 to 87.144; p =0.030) was identified as an independent risk factor for difficult intubation. Patients with haematoma had longer hospitalisation duration (p <0.001) and greater costs associated with their stay (p <0.001).Conclusion ACCF and elevated maximum MAP during the recovery period were independent risk factors for postoperative haematoma following ACSS. Patients with post-ACSS haematoma are at high risk of a difficult airway, with retropharyngeal haematoma being strongly associated with challenging airway management. Postoperative haematoma was associated with longer hospitalisation duration and greater costs.Trial registration number China Clinical Trial Registry: ChiCTR2400086263. |
| format | Article |
| id | doaj-art-33725aedf7bd4da8ad5737fe2836524c |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-33725aedf7bd4da8ad5737fe2836524c2025-08-20T02:26:16ZengBMJ Publishing GroupBMJ Open2044-60552025-04-0115410.1136/bmjopen-2024-090547Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control studyJiao Li0Jun Wang1Min Li2Yongzheng Han3Mao Xu4Xiangyang Guo5Yang Tian6Guangjin Zhou7Mingya Wang8Yinyin Qu9Shenglin Wang10Department of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Radiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Anesthesiology, Peking University Third Hospital, Beijing, ChinaDepartment of Orthopaedics, Peking University Third Hospital, Beijing, ChinaObjective The aim of this study was to investigate the incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery (ACSS).Design A retrospective nested case-control study.Setting A tertiary hospital in China.Participants A total of 13 523 patients within a single-centre longitudinal ACSS cohort were identified from March 2013 to February 2022. Patients with postoperative haematoma after ACSS were enrolled as the haematoma group, and others in the cohort without haematoma were randomly selected as the non-haematoma group by individually matching with the same operator, same gender, same surgery year and similar age (±5 years) at a ratio of 4:1. Subsequently, patients with haematoma were included in a subgroup for analysis.Primary outcome measures Postoperative haematoma and difficult intubation prior to haematoma evacuation.Results The incidence of postoperative haematoma out of all ACSS was 0.4% (55/13 523). A total of 275 patients were enrolled in the study, including 55 patients in the haematoma group and 220 patients in the non-haematoma group. Anterior cervical corpectomy and fusion (ACCF) (OR 2.459; 95% CI 1.302 to 4.642; p =0.006) and the maximum mean arterial pressure (MAP) during recovery (OR 1.030; 95% CI 1.003 to 1.058; p =0.028) were identified as independent risk factors for haematoma. In the subgroup analysis, 29% of patients with haematoma experienced difficult intubation, and retropharyngeal haematoma (OR 10.435; 95% CI 1.249 to 87.144; p =0.030) was identified as an independent risk factor for difficult intubation. Patients with haematoma had longer hospitalisation duration (p <0.001) and greater costs associated with their stay (p <0.001).Conclusion ACCF and elevated maximum MAP during the recovery period were independent risk factors for postoperative haematoma following ACSS. Patients with post-ACSS haematoma are at high risk of a difficult airway, with retropharyngeal haematoma being strongly associated with challenging airway management. Postoperative haematoma was associated with longer hospitalisation duration and greater costs.Trial registration number China Clinical Trial Registry: ChiCTR2400086263.https://bmjopen.bmj.com/content/15/4/e090547.full |
| spellingShingle | Jiao Li Jun Wang Min Li Yongzheng Han Mao Xu Xiangyang Guo Yang Tian Guangjin Zhou Mingya Wang Yinyin Qu Shenglin Wang Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study BMJ Open |
| title | Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study |
| title_full | Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study |
| title_fullStr | Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study |
| title_full_unstemmed | Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study |
| title_short | Incidence, risk factors and airway management of postoperative haematoma following anterior cervical spine surgery: a retrospective nested case-control study |
| title_sort | incidence risk factors and airway management of postoperative haematoma following anterior cervical spine surgery a retrospective nested case control study |
| url | https://bmjopen.bmj.com/content/15/4/e090547.full |
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