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

Head Neck. 2018 Jun;40(6):1219-1227. doi: 10.1002/hed.25102. Epub 2018 Apr 1.


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.

Keywords: head and neck cancer; length of stay; postoperative cervical hematoma; postoperative neck hematoma; risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Female
  • Head and Neck Neoplasms / surgery*
  • Health Care Costs*
  • Hematoma / economics*
  • Hematoma / etiology*
  • Hematoma / therapy
  • Humans
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications / economics*
  • Postoperative Complications / etiology*
  • Postoperative Complications / therapy
  • Risk Factors