Risk factors for cervical hematoma requiring surgical evacuation after anterior cervical discectomy and fusion and...

Postoperative cervical hematoma requiring surgical evacuation after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) is rare but life-threatening. Data on incidence and risk factors is limited, inconsistent, and largely derived from heterogeneous administrative databases.

To characterize the incidence and independent risk factors for postoperative cervical hematoma in a large single-institution consecutive series, as well as to evaluate the roles of Ear/Nose/Throat surgeon (ENT) involvement and drain use/type.

Retrospective cohort study.

A total of 6,084 consecutive ACDF/CDR patients at a single academic institution.

Cervical hematoma requiring surgical evacuation.

Univariate and multivariable logistic regression, 1:1 propensity score matching without replacement to assess the impact of ENT involvement and drain type.

Incidence was 0.41% (25/6,084). On univariate analysis, male sex (80.0% vs. 56.6%, p=.024), clotting disorder (OR 3.78, p=.017), postoperative antihypertensive use (OR 2.36, p=.042), and ≥4 surgical levels (OR 4.19, p=.022) were associated with increased risk. On multivariable analysis, male sex (aOR 2.99, p=.029) and ≥4 surgical levels (aOR 3.20, p=.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=.001) or no drain (OR 9.15, p<.001).

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.