Peri-Operative Blood Pressure Trends in Rhytidectomy

Goals/Purpose: Hematoma is a feared complication after rhytidectomy. The known risk factors are elevated systolic blood pressure, male gender, aspirin intake and smoking. Hypertension is one of the strongest risk factors for hematoma. Strict blood pressure control is an important method to reduce this risk, especially in male patients. Several blood pressure protocols have been previously studied, however, peri-operative blood pressure ranges and trends between different phases of care have not been well described. The primary aim of this study was to assess peri-operative blood pressure trends in different rhytidectomy patient cohorts.

Methods/Technique: A retrospective chart review of 85 patients undergoing rhytidectomy by the senior author was performed from January 2015 to December 2018. For each patient, a total of four blood pressure readings were reviewed before and after surgery: 1) pre-operatively in clinic, 2) immediately before surgery in the pre-operative area, 3) immediately after surgery in the recovery room, and 4) post-operatively in clinic. Intra-operative maximum and minimum systolic blood pressure readings were also reviewed. The same blood pressure treatment parameters were used in all patients. Patient demographics, comorbidities, and complications were also reviewed. Two-sample one-tail T-tests were performed assuming equal variances for sub-group analyses, with p<0.05 considered significant.

Results/Complications: There were no hematoma complications during the study period. The mean systolic blood pressure (SBP) overall for all patients pre-operatively in clinic was 126.55 (SD=15.51), immediately pre-op was 122.08 (SD=19.40), immediately after surgery was 100.54 (SD=13.40), and post-operatively in clinic was 129.11 (SD=21.04). Sub-group analysis by comorbidity revealed that patients with hypertension (n=38) had higher mean SBP when compared to non-hypertensive patients (n=47) immediately before surgery in the pre-operative area (p=0.042) and intraoperatively (maximal SBP, p=0.041). Sub-group analysis by gender revealed no difference in blood pressure between males (n=14) and females (n=71) across all phases of care. However, hypertensive females (n=28) had a higher SBP immediately before surgery (p=0.034) compared to non-hypertensive females (n=43).

Conclusion: In this study, we report blood pressure trends at various times before and after rhytidectomy. Hypertensive patients on average have a higher SBP immediately pre-operatively and had a higher intraoperative maximal SBP. More data is needed to corroborate and reproduce this trend, especially in the male rhytidectomy cohort. This study highlights the importance of stringent blood pressure control in the known hypertensive patient.