European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Excessive intraoperative diastolic blood pressure decrease during anesthesia lead to a higher risk of postoperative hematoma following anterior cervical discectomy and fusion (ACDF): a single-center study of 10,615 patients.
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Jin Jiyan, Qu Ruomu, Wang Ben, Wang Haoxiang, Yi Ziqi, Zhou Feifei
Аннотация
PURPOSE: Postoperative hematoma (PH) after anterior cervical discectomy and fusion (ACDF) is a serious complication that requires urgent intervention. Many surgeons prefer maintaining relatively low blood pressure during surgery to minimize blood loss; however, the effect of this practice on the risk of PH remains unclear. This study aims to investigate how perioperative blood pressure management influences the risk of PH following ACDF.
METHODS: We reviewed consecutive patients who underwent ACDF at a single institution from January 2010 to December 2021. Patients who developed postoperative hematoma (PH) were classified as the hematoma group. For each PH patient, three control subjects who underwent same surgery within the adjacent month were randomly selected, forming a control group. Potential risk factors were collected, including demographic data, comorbidities, surgical characteristics, coagulation function, and perioperative blood pressure. Univariate and multivariable analyses were conducted to identify risk factors for PH.
RESULTS: Among 10,615 ACDF cases, 26 (0.24%) developed PH. All patients underwent hematoma evacuation, and most experienced symptom relief after surgery, except for one patient who unfortunately died from ischemic hypoxic encephalopathy. The PH group exhibited significantly higher preoperative diastolic blood pressure (DBP), pulse rate, and a more pronounced decrease in intraoperative DBP. Multivariable analysis indicated that a greater intraoperative decrease in DBP is an independent risk factor for PH. The area under curve was 0.695, and the cut-off value of DBP decrease was 19.5 mmHg.
CONCLUSION: Excessive intraoperative DBP decrease might be associated with higher risk of PH after ACDF. We recommend limiting intraoperative DBP decreases to 19.5 mmHg to mitigate this risk.
METHODS: We reviewed consecutive patients who underwent ACDF at a single institution from January 2010 to December 2021. Patients who developed postoperative hematoma (PH) were classified as the hematoma group. For each PH patient, three control subjects who underwent same surgery within the adjacent month were randomly selected, forming a control group. Potential risk factors were collected, including demographic data, comorbidities, surgical characteristics, coagulation function, and perioperative blood pressure. Univariate and multivariable analyses were conducted to identify risk factors for PH.
RESULTS: Among 10,615 ACDF cases, 26 (0.24%) developed PH. All patients underwent hematoma evacuation, and most experienced symptom relief after surgery, except for one patient who unfortunately died from ischemic hypoxic encephalopathy. The PH group exhibited significantly higher preoperative diastolic blood pressure (DBP), pulse rate, and a more pronounced decrease in intraoperative DBP. Multivariable analysis indicated that a greater intraoperative decrease in DBP is an independent risk factor for PH. The area under curve was 0.695, and the cut-off value of DBP decrease was 19.5 mmHg.
CONCLUSION: Excessive intraoperative DBP decrease might be associated with higher risk of PH after ACDF. We recommend limiting intraoperative DBP decreases to 19.5 mmHg to mitigate this risk.