Cargando…
Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis
BACKGROUND: Acute airway obstruction (AAO) after anterior cervical fusion (ACF) can be caused by postoperative retropharyngeal hematoma, which requires urgent recognition and treatment. However, the causes, evaluation, and appropriate treatment of this complication are not clearly defined. The purpo...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5270356/ https://www.ncbi.nlm.nih.gov/pubmed/28126028 http://dx.doi.org/10.1186/s13018-017-0517-z |
_version_ | 1782501174997417984 |
---|---|
author | Song, Kyung-Jin Choi, Byung-Wan Lee, Dong-Hyun Lim, Dong-Ju Oh, Seung-Yeol Kim, Sung-Soo |
author_facet | Song, Kyung-Jin Choi, Byung-Wan Lee, Dong-Hyun Lim, Dong-Ju Oh, Seung-Yeol Kim, Sung-Soo |
author_sort | Song, Kyung-Jin |
collection | PubMed |
description | BACKGROUND: Acute airway obstruction (AAO) after anterior cervical fusion (ACF) can be caused by postoperative retropharyngeal hematoma, which requires urgent recognition and treatment. However, the causes, evaluation, and appropriate treatment of this complication are not clearly defined. The purpose of this retrospective review of a prospective database was to investigate etiologic factors related to the development of AAO due to postoperative hematoma after ACF and formulate appropriate prevention and treatment guidelines. METHODS: Cervical spinal cases treated at our academic institutions from 1998 to 2013 were evaluated. Demographic data, including factors related to hemorrhagic tendency, and operative data were analyzed. Patients who developed a hematoma were compared with those who did not to identify risk factors. Cases complicated by hematoma were reviewed, and times until development of hematoma and surgical evacuation were determined. Degrees of airway compromise and patient behavior were classified and evaluated. Treatment was selected according to the patient’s status. RESULTS: Among 785 ACF procedures performed, there were nine cases (1.15%) of AAO. None of these nine patients had preoperative risk factors. In six patients (67%), the hematoma occurred within 24 h, whereas three patients (33%) presented with hematoma at a median of 72 h postoperatively. Four of the nine patients with AAO underwent evacuation of the hematoma. Two patients with inspiratory stridor, anterior neck swelling, and facial edema progressed to respiratory distress and their hematomas were removed by surgery, during which, sustained superficial venous bleeding was confirmed. Intubation was attempted several times in one patient with cyanosis, but is unsuccessful; cricothyroidotomy was performed in this patient and pumping in the small muscular arterial branches was confirmed in the operating room. All of the patients recovered without any complications. CONCLUSIONS: With rapid recognition and appropriate treatment, there were no long-term complications caused by postoperative hematoma. There were no specific preoperative risk factors for hematoma. Systematic evaluation and appropriate management can be helpful for preventing serious complications after development of a postoperative hematoma. |
format | Online Article Text |
id | pubmed-5270356 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52703562017-02-01 Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis Song, Kyung-Jin Choi, Byung-Wan Lee, Dong-Hyun Lim, Dong-Ju Oh, Seung-Yeol Kim, Sung-Soo J Orthop Surg Res Research Article BACKGROUND: Acute airway obstruction (AAO) after anterior cervical fusion (ACF) can be caused by postoperative retropharyngeal hematoma, which requires urgent recognition and treatment. However, the causes, evaluation, and appropriate treatment of this complication are not clearly defined. The purpose of this retrospective review of a prospective database was to investigate etiologic factors related to the development of AAO due to postoperative hematoma after ACF and formulate appropriate prevention and treatment guidelines. METHODS: Cervical spinal cases treated at our academic institutions from 1998 to 2013 were evaluated. Demographic data, including factors related to hemorrhagic tendency, and operative data were analyzed. Patients who developed a hematoma were compared with those who did not to identify risk factors. Cases complicated by hematoma were reviewed, and times until development of hematoma and surgical evacuation were determined. Degrees of airway compromise and patient behavior were classified and evaluated. Treatment was selected according to the patient’s status. RESULTS: Among 785 ACF procedures performed, there were nine cases (1.15%) of AAO. None of these nine patients had preoperative risk factors. In six patients (67%), the hematoma occurred within 24 h, whereas three patients (33%) presented with hematoma at a median of 72 h postoperatively. Four of the nine patients with AAO underwent evacuation of the hematoma. Two patients with inspiratory stridor, anterior neck swelling, and facial edema progressed to respiratory distress and their hematomas were removed by surgery, during which, sustained superficial venous bleeding was confirmed. Intubation was attempted several times in one patient with cyanosis, but is unsuccessful; cricothyroidotomy was performed in this patient and pumping in the small muscular arterial branches was confirmed in the operating room. All of the patients recovered without any complications. CONCLUSIONS: With rapid recognition and appropriate treatment, there were no long-term complications caused by postoperative hematoma. There were no specific preoperative risk factors for hematoma. Systematic evaluation and appropriate management can be helpful for preventing serious complications after development of a postoperative hematoma. BioMed Central 2017-01-26 /pmc/articles/PMC5270356/ /pubmed/28126028 http://dx.doi.org/10.1186/s13018-017-0517-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Song, Kyung-Jin Choi, Byung-Wan Lee, Dong-Hyun Lim, Dong-Ju Oh, Seung-Yeol Kim, Sung-Soo Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
title | Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
title_full | Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
title_fullStr | Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
title_full_unstemmed | Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
title_short | Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
title_sort | acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5270356/ https://www.ncbi.nlm.nih.gov/pubmed/28126028 http://dx.doi.org/10.1186/s13018-017-0517-z |
work_keys_str_mv | AT songkyungjin acuteairwayobstructionduetopostoperativeretropharyngealhematomaafteranteriorcervicalfusionaretrospectiveanalysis AT choibyungwan acuteairwayobstructionduetopostoperativeretropharyngealhematomaafteranteriorcervicalfusionaretrospectiveanalysis AT leedonghyun acuteairwayobstructionduetopostoperativeretropharyngealhematomaafteranteriorcervicalfusionaretrospectiveanalysis AT limdongju acuteairwayobstructionduetopostoperativeretropharyngealhematomaafteranteriorcervicalfusionaretrospectiveanalysis AT ohseungyeol acuteairwayobstructionduetopostoperativeretropharyngealhematomaafteranteriorcervicalfusionaretrospectiveanalysis AT kimsungsoo acuteairwayobstructionduetopostoperativeretropharyngealhematomaafteranteriorcervicalfusionaretrospectiveanalysis |