Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2019 Apr 15;44(8):543-549. doi: 10.1097/BRS.0000000000002885.
Retrospective study of prospectively collected data.
To determine the incidence, timing, risk factors, and clinical implications of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF).
Postoperative hematomas requiring reoperation are rare but potentially catastrophic complications after ACDF. However, there has been a lack of large cohort studies investigating these complications in the ACDF population despite increasing outpatient procedure volume.
Patients who underwent ACDF in the 2012 to 2016 National Surgical Quality Improvement Program database were identified. The primary outcome was an occurrence of hematoma requiring reoperation within 30 days postoperatively. Risk factors for this outcome were identified using multivariate regression. Postoperative length of stay, subsequent complications, and mortality were compared between patients who did and did not develop a hematoma requiring reoperation.
A total of 37,261 ACDF patients were identified, of which 148 (0.40%) developed a hematoma requiring reoperation (95% confidence interval [CI], 0.33%-0.46%). Of the cases that developed this complication, 37% occurred after discharge. Risk factors for the development of hematoma requiring reoperation were multilevel procedures (most notably ≥3 levels, relative risk [RR] = 3.14, 95% CI = 1.86-5.32, P < 0.001), preoperative international normalized ratio >1.2 (RR = 2.85, 95% CI = 1.42-5.71, P = 0.006), lower BMI (notably body mass index ≤24, RR = 2.11, 95% CI = 1.21-3.67, P = 0.008), American Society of Anesthesiologists classification ≥3 (RR = 2.07, 95% CI = 1.47-2.91, P < 0.001), preoperative anemia (RR = 1.71, 95% CI = 1.12-2.63, P = 0.027), and male sex (RR = 1.67, 95% CI = 1.18-2.37, P = 0.004). In addition, patients who developed a hematoma requiring reoperation before discharge had a longer length of stay. Further, those who developed a hematoma requiring reoperation were at higher risk for subsequent ventilator requirement, deep wound infection, pneumonia, and reintubation.
Postoperative hematoma requiring reoperation occurred in approximately 1 in 250 patients after ACDF. High-risk patients should be closely monitored through the perioperative period.
前瞻性收集数据的回顾性研究。
确定颈椎前路椎间盘切除融合术（ACDF）后需要再次手术的术后血肿的发生率、时间、危险因素和临床意义。
颈椎前路椎间盘切除融合术后出现需要再次手术的血肿是一种罕见但潜在灾难性的并发症。然而，尽管门诊手术量不断增加，但在 ACDF 人群中，仍缺乏大型队列研究来调查这些并发症。
在 2012 年至 2016 年国家手术质量改进计划数据库中，确定接受 ACDF 的患者。主要结局是术后 30 天内发生需要再次手术的血肿。使用多变量回归确定该结局的危险因素。比较发生和未发生需要再次手术血肿的患者的术后住院时间、后续并发症和死亡率。
共确定了 37261 例 ACDF 患者，其中 148 例（0.40%）发生需要再次手术的血肿（95%置信区间[CI]，0.33%-0.46%）。在发生这种并发症的病例中，37%发生在出院后。需要再次手术血肿的发展危险因素包括多节段手术（特别是≥3 个节段，相对风险[RR] = 3.14，95%CI = 1.86-5.32，P < 0.001）、术前国际标准化比值>1.2（RR = 2.85，95%CI = 1.42-5.71，P = 0.006）、较低的 BMI（特别是 BMI≤24，RR = 2.11，95%CI = 1.21-3.67，P = 0.008）、美国麻醉医师协会分类≥3（RR = 2.07，95%CI = 1.47-2.91，P < 0.001）、术前贫血（RR = 1.71，95%CI = 1.12-2.63，P = 0.017）和男性（RR = 1.67，95%CI = 1.18-2.37，P = 0.004）。此外，在出院前发生需要再次手术血肿的患者住院时间较长。此外，发生需要再次手术血肿的患者发生呼吸机需求、深部伤口感染、肺炎和重新插管的风险更高。
颈椎前路椎间盘切除融合术后约每 250 例患者中就有 1 例发生需要再次手术的血肿。高危患者应在围手术期密切监测。
3 级。
