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 surgically, and may prolong both hospital stay and the total recovery time following surgery. Intraoperative hypotension has been implicated in the development of various complications, but has not been previously studied in relation to breast reduction. A retrospective analysis of 238 breast reductions was performed with the aim of identifying risk factors for the development of wound haematoma after breast reduction. The operative time was divided into three equal periods and, in our experience, haemostasis was achieved in the middle period. In our series, 16 patients developed a postoperative wound haematoma; only four patients required operative evacuation (1.7%). Subcutaneous heparin prophylaxis, the level of the surgical team and the weight of tissue resected did not significantly affect the likelihood of wound haematoma. The lowest and the peak values of systolic blood pressure and the mean blood pressure (diastolic + 1/3 pulse) were significantly lower in the middle period of the operation in patients who developed a haematoma (P values: 0.012, 0.021 and 0.005, respectively). Univariate logistic regression analysis showed the same significant findings (P values: 0.0014, 0.021 and 0.0059, respectively). Multivariate stepwise logistic regression showed that the lowest systolic blood pressure in the middle period was significantly lower in the haematoma group than in the non-haematoma group (P=0.0007). Intraoperative hypotension in the middle period of the operation, which is usually the period when haemostasis is achieved, is associated with the development of postoperative wound haematoma. (C) 2001 The British Association of Plastic Surgeons.