Risk factors and treatment of difficult intubation during retropharyngeal hematoma evacuation following anterior cervical spine surgery: a retrospective study

Abstract Background Postoperative retropharyngeal hematoma (RH) following anterior cervical spine surgery (ACSS) can cause acute airway obstruction (AAO). In severe cases, difficult intubation (DI) may occur, posing serious challenges to airway management. The purpose of this retrospective study was to investigate the incidence and risk factors for DI and to explore airway management in RH evacuation following ACSS. Methods A series of 40 consecutive patients who underwent RH evacuation following ACSS were retrospectively identified at Peking University Third Hospital from March 2010 to March 2023. Patients were categorized into the DI group or no-DI group. Demographic, clinical symptom, and airway assessment data were recorded to identify risk factors for DI. Results The incidence of postoperative RH out of all ACSS surgery was 0.2% (40/16,127). General anesthesia was applied for RH evacuation in all 40 patients. The incidence of DI during RH evacuation was 35% (14/40). Thirty-nine patients were successfully treated and discharged, and one patient died of hypoxic-ischemic encephalopathy 24 days after RH evacuation. Class III & IV acute airway obstruction (AAO) (odds ratio [OR], 5.384; 95% confidence interval [CI], 1.098–26.398; P = 0.038) and time interval between symptom onset and airway intervention (TI) (OR, 2.073; CI [1.072–4.010]; P = 0.030) were found to be independent risk factors for DI. Patients with DI had longer tracheal catheter retention times and longer durations of stay in the intensive care unit (ICU) (P < 0.001). Conclusions Class III & IV AAO and TI are independent risk factors for DI during RH evacuation following ACSS. DI is associated with longer retention of the tracheal catheter and longer duration of stay in the ICU. Appropriate airway intervention should be performed for high-risk patients. Trial registration: ChiCTR2200061982