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Perioperative blood pressure control reduces hematoma formation in face-lift patients

Researchers found meticulously controlling patients' blood pressure perioperatively resulted in a significant reduction in the rate of postoperative hematoma formation among patients who underwent face-lift procedures.

In a retrospective chart review, the researchers analyzed data from 1,089 patients who underwent rhytidectomy between April 1990 and January 2013. All patients had participated in a predetermined antihypertensive protocol before surgery, which included the routine use of transdermal clonidine. The goal of therapy was a target intraoperative systolic blood pressure (BP) of lower than 140 mm Hg, with hypertension defined as a systolic BP of higher than 140 mm Hg.

The researchers assessed the patients' anesthesia records to determine the number of hypertensive episodes recorded in 15-minute increments. Patients who were observed to have episodes of intraoperative hypertension were further categorized into one of two groups: those with a systolic BP of 140 mm Hg to 160 mm Hg, and those with a systolic BP of higher than 160 mm Hg. Postoperatively, all of the patients' BPs were monitored closely in the recovery room, and patients were monitored for complications.

Cardiac disease was present in 52 patients, pulmonary disease was present in 26 patients, hypertension was present in 165 patients and diabetes was present in five patients. Twenty-six patients who were smokers stopped smoking 4 weeks before undergoing surgery.

Before surgery, 170 patients were classified as hypertensive; postoperatively, 355 patients were hypertensive. Ten of the 1,089 patients (mean age: 63 years) experienced a postoperative hematoma.

Among the patients who developed a hematoma postoperatively, two had a preoperative systolic BP of 140 mm Hg or higher; both received additional antihypertensives as part of the approved treatment protocol. Six patients were observed to have intraoperative BPs within the 140 mm Hg to 160 mm Hg range, and one patient was observed to have an intraoperative BP higher than 160 mm Hg. However, these fluctuations intraoperatively were not correlated with the development of postoperative hematomas, according to the researchers.

During postanesthesia care, 354 patients had at least one episode of hypertension that required additional treatment.

The researchers found male sex to be significantly related to the development of postoperative hematoma. Pulmonary disease was also found to be significant, according to the researchers. - by Abigail Sutton

Disclosures: Ramanadham reports no relevant financial disclosures. Please see the full study for a list of all other authors' financial disclosures.