Wound hematoma after anterior cervical spine surgery: A retrospective study of risk factors analysis

Abstract Background: The postoperative wound hematoma after anterior cervical spinal surgery is a very critical complication. We aim to explore the risk factors independently associated with postoperative wound hematoma in patients who have undergone anterior cervical spine surgery. Methods: Clinical data of patients with cervical spondylosis or cervical disc herniation who underwent anterior cervical spine surgery by the senior author from January 2011 to December 2017 were evaluated. A multivariate logistic regression was conducted to compare the hematoma group and the non-hematoma group in order to find out which factors that were independently associated with hematoma formation. Mann-Whitney U test was conducted to compare the Neck disability Index score in two groups. Results: A total of 678 patients met the criteria who underwent anterior cervical spine surgery. 13 patients were identified as wound hematoma who have undergone hematoma evacuation, in which hemorrhage sites were found. Multivariate logistic regression identified that history of hypertension (p=0.039 OR=4.42 95%CI 1.08-18.07) and therapeutic heparin use (p=0.020 OR=4.58 95%CI 1.27-16.59) were independent risk factors of hematoma formation. The t-test shows no significant differences between the hematoma group and no hematoma group in APTT and PT levels (p>0.05). Mann-Whitney U test indicates that there was no difference in NDI scores between the two groups(p>0.05). Conclusion: History of hypertension and therapeutic heparin use are risk factors for hematoma formation. Meticulous hemostasis, moderate muscle subtraction, and perioperative airway management are critical in avoiding hematoma development. Hematoma evacuation as quickly as possible is necessary. Key word: wound hematoma, logistic models, risk factors, hypertension, heparin use, hemostasis.