Intraoperative Systolic Blood Pressure as a Significant Predictor of Postoperative Hematoma Following Facelift: Single-Surgeon Experience of 118 Consecutive Facelifts

Abstract Background Although there exists ample evidence on the impact of perioperative blood pressure on hematoma incidence following facelift, the association of elevated or labile intraoperative blood pressure with postoperative hematoma remains to be explored. Objectives The authors evaluated the association of elevated or labile intraoperative systolic blood pressure (SBP) with postoperative hematoma, based on the senior author's single surgeon experience of 118 consecutive facelifts. Methods A multivariate logistic regression was conducted using complete demographic, procedure-related, blood pressure–related, and outcomes-related data, with the outcome of interest representing postoperative hematoma. One-way analysis of variance and linear regression analyses were performed to assess for significant associations between a preoperative history of hypertension and a tendency to demonstrate elevated or labile intraoperative SBP. A Fisher's exact test was subsequently applied to assess for specific intraoperative SBP measurement cutoffs significantly associated with postoperative hematoma, including maximum recorded intraoperative SBP, and the specific degree of intraoperative SBP fluctuation. Results Multivariate logistic regression demonstrated no statistically significant patient- or procedure-related demographic predictors of postoperative hematoma. With aggressive treatment of preoperative hypertension, high preoperative SBP was not found to be a significant predictor of postoperative hematoma following facelift, although this approached statistical significance (P = .05). In contrast, labile intraoperative SBP (maximum recorded intraoperative SBP minus minimum recorded intraoperative SBP; P = .026) and high immediate postoperative SBP (P = .002) were both independent and statistically significant predictors of postoperative hematoma. Patients with a preoperative history of hypertension, and more specifically those with elevated SBP measurements in the preoperative clinic, were more likely to demonstrate labile (P = .007) or elevated (P = .005) intraoperative SBP during facelift surgery. Specifically, maximum recorded intraoperative SBP ≥155 mmHg (P = .045) and maximum intraoperative SBP fluctuations ≥80 mmHg (P = .036) were found to be significantly associated with hematoma. Conclusions A multimodal approach is necessary to control perioperative systolic blood pressure within the strict <120 mmHg target demonstrated to significantly decrease hematoma incidence. The senior author's preference is for intraoperative SBP to remain within a strict 90 to 100 mmHg range. In contrast to hypertension that is aggressively treated and successfully controlled, hypertension that is difficult to control intraoperatively may be a predictor of systolic blood pressure that is difficult to control postoperatively, and therefore a significant risk factor for postoperative hematoma following facelift. Level of Evidence: 4 (Therapeutic)