Expert consensus on the prevention and treatment of asphyxia and anterior cervical hematoma after anterior cervical surgery

Background: Asphyxia caused by an anterior cervical hematoma compressing the airway is one of the most catastrophic complications of anterior cervical surgery. This consensus formulates recommendations on the key issues in the prevention and treatment of asphyxia and anterior cervical hematoma after anterior cervical surgery, providing a reference for standardized clinical management. Methods: Following the modified Delphi method and the standards of the WHO Handbook for Guideline Development and the Guiding Principles for the Development/Revision of Clinical Practice Guidelines in China (2022 Edition), a panel of 67 experts (predominantly spinal surgeons) from across China was convened. Nineteen clinical questions (items 6 to 24 of the questionnaire) were developed using the PICO (Population, Intervention, Comparison, Outcome) framework. An agreement rate of 70% or higher was defined as consensus, ≥50% and <70% as majority preference, and below 50% as divergent opinions. Results: Nineteen recommendations were formulated (12 strong and 7 weak; 10 supported by level B evidence and 9 by level D evidence). Anterior cervical hematoma compressing the airway was identified as the primary risk factor (6.47/7 points); progressive neck swelling as the primary early warning sign (4.77/6 points); the first 24 hours after surgery as the key monitoring window (91.0%); and drain placement (100%) with a single drain (92.5%) as the preferred drainage strategy. Anesthesiologist judgment on the safety of extubation was the primary indication for ICU transfer (80.6%), and small, thin dressings exposing the operative field were preferred (73.1%). Bedside wound opening for decompression was rated the first-line emergency measure (4.64/5 points), and a rapid coordinated response involving the surgical, anesthesiology, and nursing teams was the preferred collaboration model (3.98/5 points). Conclusions: This consensus provides evidence-based recommendations informed by expert experience for the prevention and treatment of asphyxia and anterior cervical hematoma after anterior cervical surgery. Consensus was not reached on several issues, which warrant further research, including drain position, routine monitoring intensity and setting, and the timing of high-flow oxygen therapy.