Novel Risk Factors for Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-11-04 DOI:10.1097/BSD.0000000000001716

Dana G Rowe, Seeley Yoo, Connor Barrett, Emily Luo, Alissa Arango, Matthew Morris, Kerri-Anne Crowell, Russel R Kahmke, C Rory Goodwin, Melissa M Erickson

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Abstract

Study design: Retrospective cohort study.

Objective: To investigate the correlation between comorbid chronic obstructive pulmonary disease (COPD), asthma, tobacco use, and the incidence of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF).

Summary of background data: Prior studies have identified general risk factors such as multilevel fusion and coagulopathy. However, specific coughing-related factors like COPD, asthma, and tobacco use have not been extensively investigated.

Methods: Patients who underwent single or multilevel ACDF between 2011 and 2021 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver database. The primary outcome was the occurrence of postoperative hematoma requiring reoperation within 30 days. χ2 tests and t tests compared groups, and multivariable logistic regression identified predictors for postoperative hematoma.

Results: Among 399,900 patients with ACDF, 901 (0.2%) developed postoperative hematoma requiring reoperation within 30 days. Patients with postoperative hematoma were older (58 vs. 55, P<0.001) and predominantly male (62.5% vs. 44.9%, P<0.001). After adjustment, tobacco use and comorbid COPD were associated with postoperative hematoma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.10-1.47; P<0.001 and OR, 1.41; 95% CI, 1.21-1.64; P<0.001, respectively). Comorbid asthma was not a significant risk factor. Additional risk factors included comorbid hypertension (OR, 1.46; 95% CI, 1.18-1.82; P<0.001), coagulopathy (OR, 1.50; 95% CI, 1.24-1.81; P<0.001), anemia (OR, 1.38; 95% CI, 1.17-1.62; P<0.05), and history of deep vein thrombosis (OR, 1.93; 95% CI, 1.44-2.54; P<0.001).

Conclusion: Tobacco use and COPD were identified as novel risk factors for postoperative hematoma formation requiring reoperation after ACDF. Recognizing these modifiable factors, providers may consider postponing nonemergent ACDFs until patients undergo smoking cessation programs or receive optimal COPD management.

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颈椎前路椎间盘切除和融合术后血肿需要再次手术的新风险因素。

研究设计回顾性队列研究：调查合并慢性阻塞性肺病（COPD）、哮喘、吸烟与颈椎前路椎间盘切除及融合术（ACDF）术后血肿需要再次手术的发生率之间的相关性：背景数据摘要：先前的研究已经确定了一般的风险因素，如多级融合和凝血功能障碍。然而，与咳嗽相关的特殊因素，如慢性阻塞性肺病、哮喘和吸烟，尚未得到广泛研究：利用PearlDiver数据库中的当前程序术语（CPT）代码，对2011年至2021年间接受单层或多层ACDF手术的患者进行识别。χ2检验和t检验对各组进行比较，多变量逻辑回归确定了术后血肿的预测因素：在 399,900 例 ACDF 患者中，有 901 例（0.2%）出现术后血肿，需要在 30 天内再次手术。术后血肿患者的年龄较大（58 岁对 55 岁）：吸烟和慢性阻塞性肺病是 ACDF 术后血肿形成并需要再次手术的新风险因素。认识到这些可改变的因素，医疗服务提供者可考虑推迟非急诊 ACDF，直到患者接受戒烟计划或接受最佳慢性阻塞性肺病治疗。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.