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

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. χ 2 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.