Neck hematoma after major head and neck surgery: Risk factors, costs, and resource utilization

Background: Postoperative cervical hematoma after major head and neck surgery is a feared complication. However, risk factors for developing this complication and attributable costs are not well-established. Methods: The Nationwide Inpatient Sample database was utilized compare patients with and without postoperative cervical hematoma. Logistic regression was used to analyze risk factors for hematoma formation and 30-day mortality. Total inpatient length of stay (LOS) and costs were fit to generalized linear models. Results: Of 32 071 patients, 1098 (3.4%) experienced a postoperative cervical hematoma. Male sex (odds ratio [OR] 1.38; P <.0001), black race (OR 1.35; P =.010), 4 or more comorbidities (OR 1.66; P <.0001), or presence of a preoperative coagulopathy (OR 6.76; P <.0001) were associated. Postoperative cervical hematoma was associated with 540% increased odds of death (P <.0001). The LOS and total excess costs were 5.14 days (P <.0001) and $17 887.40 (P <.0001), respectively. Conclusion: Although uncommon, postoperative cervical hematoma is a life-threatening complication of head and neck surgery with significant implications for outcomes and resource utilization.