The Impact of Perioperative Blood Pressure on Hematoma Development After Panniculectomy

Abstract

Purpose Hematoma affects 10% to 13% of patients undergoing panniculectomy. Although elevated perioperative blood pressure has been associated with hematoma after rhytidectomy, this has not been established for panniculectomy. We sought to determine the impact of perioperative blood pressure on hematoma development in patients undergoing panniculectomy. Methods A retrospective review was performed on patients undergoing isolated panniculectomy procedures. Blood pressure parameters recorded included systolic blood pressures (SBPs), diastolic blood pressures (DBPs), and mean arterial pressure. The mean, peak, and trough blood pressure values were recorded. Preoperative, intraoperative, and postoperative blood pressures were recorded, and differences between phases were calculated. Univariate and multivariate logistic regressions were performed. Results One hundred forty-three patients were identified, which included 84% (n = 120) women and 17% (n = 23) men. A history of hypertension was present in 55% (n = 79) of patients, of which 91% (n = 72) were medically controlled. Preoperative antiplatelet or anticoagulation was used in 21% (n = 31) of patients. Seven patients (5%) developed a hematoma, of which 5 required operative drainage. Development of hematoma was not associated with patient, surgical, or postoperative pain variables. There was an association between hematoma and elevated postoperative blood pressures on univariate and multivariate analyses. The mean peak SBP in the hematoma group was 160 mm Hg in comparison to 141 mm Hg in the nonhematoma group. For each 10-mm Hg increase in postoperative peak SBP, the odds of a hematoma increased by 2.8 times. When comparing phases of care, hematoma patients had similar intraoperative and postoperative peak SBP, but their postoperative SBP was 19 mm Hg higher than preoperative baseline. Conversely, nonhematoma patients had a postoperative blood pressure that was similar to their preoperative baseline and 20 mm Hg lower than their intraoperative values. Conclusions Hematoma is associated with elevated postoperative blood pressures. A postoperative mean peak SBP of 160 mm Hg was associated with hematoma, and for each 10 mm Hg, the risk of hematomsa increased by 2.8 times. The risk of hematoma may be reduced by strict postoperative blood pressure control. We recommend a postoperative peak SBP goal of 140 mm Hg or less, with a value equal to or less than their preoperative baseline and 20 mm Hg lower than their intraoperative pressure.

Expansion of Renuvion Application to Areas Beyond the Submental Region: Review and Experience

“…Hypertension, in particular, is noted to be associated with hematoma formation in soft-tissue procedures. 15 , 16 Although no complications experienced in this study required reoperation, seromas and hematoma risk should be discussed with great emphasis with these patients.…”

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery

“…As such, up to one-third of weight loss patients ultimately pursue post-weight loss body contouring such as panniculectomy and abdominoplasty. 4 Benefits of undergoing panniculectomy have been well documented in the literature and include improved quality of life, improved hygiene, decreased intertriginous infection rates, and improved psychosocial well-being. 1 , 2 Despite significantly improved patient satisfaction following panniculectomy, this procedure has historically been associated with a higher complication profile, including postoperative wound infection, dehiscence, seroma, hematoma, and venous thromboembolism (VTE).…”

“…With overall complication rates ranging from 21% to 56%, previous authors have analyzed the specific complications associated with panniculectomy and have published on the importance of modifiable risk factors to mitigate any increased risk, such as BMI reduction and smoking cessation. 4 , 6-8 Given that panniculectomy is an elective surgery, reducing adverse events such as hematoma, seroma, and infection is imperative. While the risk of bleeding and seroma exists for all surgical procedures, reoperations for hematoma evacuations, repeated in-office seroma aspirations, and prolonged drain duration have been demonstrated to negatively impact patient experiences.…”