Spine Journal - 2026-09-04 - Journal Article
Risk Factors for Cervical Hematoma Requiring Surgical Evacuation After Anterior Cervical Discectomy and Fusion and Cervical Disc Replacement: A Retrospective Analysis of 6,084 Cases.
Kazarian GS, Mok JK, Dekhne M, Owusu-Sarpong S, Hirase T, Farmer J, Huang RC, Kim HJ, Iyer S, Dowdell JE, Albert TJ, Soffin EM, Beckman JD, Panzer OPF, Wetmore DS, Qureshi SA, Morse KW
Topics
Key Takeaway
Postoperative cervical hematoma requiring evacuation occurred in 0.41% of 6,084 ACDF/CDR cases, with male sex (aOR 2.99) and ≥4 surgical levels (aOR 3.20) as independent predictors, and Penrose drains associated with 9.15× higher odds versus no drain.
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Summary
This study identified independent risk factors for postoperative cervical hematoma requiring surgical evacuation in 6,084 consecutive ACDF/CDR patients at a single academic institution. Multivariable logistic regression identified male sex (aOR 2.99) and ≥4 surgical levels (aOR 3.20) as independent predictors; clotting disorder and postoperative antihypertensive use were significant on univariate analysis only. Penrose drains carried 9.15× higher odds of hematoma versus no drain, and ENT surgical involvement showed no protective effect after propensity score matching.
Key Limitation
With only 25 outcome events, the multivariable model is underpowered and susceptible to overfitting, limiting generalizability of the independent predictor estimates.
Original Abstract
BACKGROUND CONTEXT
Postoperative cervical hematoma requiring surgical evacuation after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) is rare but life-threatening. Risk factor data are limited and inconsistent, largely derived from heterogeneous administrative databases.
PURPOSE
To characterize the incidence and independent risk factors for postoperative cervical hematoma in a large single-institution consecutive series, and to evaluate the roles of ENT involvement and drain type.
DESIGN
Retrospective cohort study.
PATIENT SAMPLE
6,084 consecutive ACDF/CDR patients at a single academic institution; 25 confirmed hematoma cases identified by manual chart review.
OUTCOME MEASURES
Cervical hematoma requiring surgical evacuation.
METHODS
Univariate and multivariable logistic regression; 1:1 propensity score matching without replacement (caliper 0.2xSD) for ENT involvement and drain type. Post hoc power was assessed for key comparisons.
RESULTS
Incidence was 0.41% (25/6,084). On univariate analysis, male sex (80.0% vs 56.6%, p=0.024), clotting disorder (OR 3.78, p=0.017), postoperative antihypertensive use (OR 2.36, p=0.042), and ≥4 surgical levels (OR 4.19, p=0.022) were associated with increased risk. On multivariable analysis, male sex (aOR 2.99, p=0.029) and ≥4 surgical levels (aOR 3.20, p=0.037) were independent predictors. Surgical approach by ENT showed no association after propensity matching (OR 1.00, p=1.000). Penrose drains were associated with higher rates than closed-suction drains (OR 6.08, p=0.001) or no drain (OR 9.15, p<0.001).
CONCLUSIONS
Cervical hematoma after ACDF/CDR occurred in 0.41% of cases and was independently predicted by male sex and ≥4 surgical levels. ENT approach did not affect risk after matching. Penrose drains were associated with higher hematoma rates than closed-suction or no drain. These findings inform perioperative risk stratification and surgical decision-making.