Incidence and Risk Factors of Postoperative Hematoma Requiring Reoperation in Single-level Lumbar Fusion Surgery

STUDY DESIGN.Retrospective cohort. OBJECTIVE.The purpose of this study was to examine the incidence and risk factors for postoperative hematoma requiring reoperation in patients undergoing single-level lumbar fusion surgery. SUMMARY OF BACKGROUND DATA.Postoperative hematoma can cause devastating neurological consequences after spine surgery. Risk factors for hematoma in specific spine procedures have not been well established. METHODS.A cohort of patients undergoing single-level lumbar fusion surgery was constructed from the 2012–2013 American College of Surgeons National Surgical Quality Improvement Program dataset using Current Procedural Terminology codes (22533, 22558, 22612, 22630, and 22633). In cases requiring reoperation within 30 days after initial surgery, postoperative hematoma was identified using the ICD–9 code 998.1. Risk factors for postoperative hematoma were assessed with logistic regression modeling. RESULTS.Of 5,280 patients undergoing single-level lumbar fusion surgery, 27 patients (0.5%) developed a postoperative hematoma requiring reoperation for hematoma evacuation. A heightened incidence of postoperative hematoma was found in patients who were smokers (1.0% vs. 0.4% for non-smokers, p = 0.016) or who had a diagnosis of bleeding disorder (3.8% vs. 0.5% for those without bleeding disorder, p = 0.007). Multivariate logistic regression analysis indicated that the adjusted odds ratios for postoperative hematoma associated with smoking and bleeding disorder were 3.34 (95% confidence interval, 1.15 to 9.71) and 10.2 (95% confidence interval, 1.9 to 54.8), respectively. CONCLUSIONS.Smoking and bleeding disorder appear to be major risk factors for postoperative hematoma requiring reoperation after single-level lumbar fusion surgery. Intervention programs targeting patients with these risk factors are needed to reduce their excess risk of postoperative hematoma.Level of Evidence3