title: Facelift complications related to median and peak blood pressure evaluation.
abstract: BACKGROUND
  Hematoma remains the most challenging complication of facelifting and has been associated with male sex, hypertension, aspirin use, smoking, and high body mass index. Patients who underwent a facelift were studied to determine rates of hematoma and other complications and to identify predictive and protective factors, including meticulous analysis of perioperative blood pressure.
  
  
  METHODS
  Charts of patients who underwent a facelift from 2003 to 2011 at our institution were retrospectively reviewed. Demographic, clinical, and procedural data were collected. All postoperative complications were recorded. Data from continuous blood pressure monitoring in the operating and recovery rooms were obtained from a perioperative database and stratified by median and peak values. Logistic regression was used for data analysis.
  
  
  RESULTS
  Of the 229 patients included, the majority were female (88.2 %), mean age at presentation was 62 years, and 35.8 % had hypertension. Postoperative complications occurred in 60 patients (26.2 %). The most common complication was unfavorable scar (7.4 %), followed by hematoma (6.5 %). Male sex (P = 0.02), history of hypertension (P = 0.04), preoperative systolic blood pressure (SBP) greater than 160 mmHg (P = 0.04), and operating room peak SBP greater than 165 mmHg (P = 0.04) were predictive factors for hematoma. Recovery room peak SBP greater than 150 mmHg (P = 0.09) was also associated with hematoma. On multivariate analysis, only male sex and preoperative SBP greater than 160 mmHg remained independent risk factors for hematoma.
  
  
  CONCLUSIONS
  This study is unique in that it compares the rate of hematoma to continuous blood pressure data in the operating and recovery rooms stratified by median and peak values. Meticulous control of perioperative SBP is recommended for a safe facelift. History of hypertension, increased SBP at admission, and increased perioperative peak SBP are predictors for postoperative hematoma.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Maricevich
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Adair
authors.forename: Renata L
authors.initials: RL
authors.lastname: Maricevich
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jacobson
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006406:Hematoma / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000503:physiopathology*; D015361:Rhytidoplasty / Q000009:adverse effects*; D012307:Risk Factors