title: Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Korea.
authors.forename: Kyung-Jin
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.
authors.forename: Byung-Wan
authors.initials: BW
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.
authors.forename: Dong-Hyun
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Lim
authors.affiliation: Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea.
authors.forename: Seung-Yeol
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea. sskim@paik.ac.kr.
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000402:Airway Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Acute airway obstruction; Anterior servical fusion; Cervical spine; Hematoma