The impact of intraoperative hypotension on the development of wound haematoma after breast reduction

A wound haematoma occurring after breast reduction may need to be drained s urgically, and may prolong both hospital stay and the total recovery time f ollowing surgery. Intraoperative hypotension has been implicated in the dev elopment of various complications, but has not been previously studied in r elation to breast reduction. A retrospective analysis of 238 breast reducti ons was performed with the aim of identifying risk factors for the developm ent of wound haematoma after breast reduction. The operative time was divid ed into three equal periods and, in our experience, haemostasis was achieve d in the middle period. In our series, 16 patients developed a postoperativ e wound haematoma; only four patients required operative evacuation (1.7%). Subcutaneous heparin prophylaxis, the level of the surgical team and the w eight of tissue resected did not significantly affect the likelihood of wou nd haematoma. The lowest and the peak values of systolic blood pressure and the mean blood pressure (diastolic + 1/3 pulse) were significantly lower i n the middle period of the operation in patients who developed a haematoma (P values: 0.012, 0.021 and 0.005, respectively). Univariate logistic regre ssion analysis showed the same significant findings (P values: 0.0014, 0.02 1 and 0.0059, respectively). Multivariate stepwise logistic regression show ed that the lowest systolic blood pressure in the middle period was signifi cantly lower in the haematoma group than in the non-haematoma group (P=0.00 07). Intraoperative hypotension in the middle period of the operation, whic h is usually the period when haemostasis is achieved, is associated with th e development of postoperative wound haematoma. (C) 2001 The British Associ ation of Plastic Surgeons.