Risk factors for post-carotid endarterectomy hematoma formation.
OBJECTIVE
To identify risk factors for post-carotid endarterectomy (CEA) hematoma formation and establish the incidence of this complication at The Ottawa Hospital - Civic Campus (TOH-CC).


METHODS
A chart review of all patients who underwent CEA at TOH-CC from January 1, 1996 to December 31, 1997 was completed. Identified cases of post-CEA wound hematoma were entered into a case-control study using age and sex-matched controls from within the cohort. These matched pairs were assessed for 31 potential risk factors including demographic details, co-existing medical conditions, preoperative medications, intraoperative management, and postoperative parameters. Risk factors associated with post-CEA hematoma with P<0.05 were entered into a backward step-wise logistic regression model for multivariate analysis.


RESULTS
Charts from 249 patients were reviewed and 29 cases of post-carotid endarterectomy hematoma were identified (12% incidence). Six of the initial 31 potential risk factors emerged as univariate predictors of post-CEA hematoma formation (P<0.05): general anesthesia, carotid shunt placement, intraoperative hypotension, non-reversal of heparin, neurosurgery service, and preoperative aspirin use. Following logistic regression only non-reversal of heparin, intraoperative hypotension, and carotid shunt placement were identified as multivariate predictors of post-CEA hematoma formation. More time was spent in critical care settings (ICU/PACU) (P<0.01) and there was increased perioperative mortality (P = 0.04) within the hematoma group.


CONCLUSIONS
Post-CEA hematoma formation is associated with increased morbidity and mortality. Non-reversal of heparin, intraoperative hypotension, and carotid shunt placement are multi-variate predictors of post-CEA hematoma formation.
Self
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Department of Anesthesiology, The Ottawa Hospital - Civic Campus, Ontario, Canada.
Bryson
G L
GL
Sullivan
P J
PJ
D000368:Aged; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors