Abstract
Purpose
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 withP < 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, nonreversal of heparin, neurosurgery service, and preoperative aspirin use. Following logistic regression only nonreversal 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.
Résumé
Objectif
Identifier les facteurs de risques de formation d’un hématome post-endartériectomie carotidienne (EAC) et établir son incidence à The Ottawa Hospital — Civic Campus (TOH-CC).
Méthode
On a révisé les dossiers de tous les patients qui ont subi une EAC à TOH-CC du 1 janvier 1996 au 31 décembre 1997. Les cas d’hématome post-EAC ont été identifiés et inscrits à une étude cas-témoins appariés selon l’âge et le sexe à partir des sujets de la cohorte. Ces paires de sujets ont été évalués selon 31 facteurs de risque potentiels incluant les données démographiques, la coexistence de problèmes médicaux, la médication préopératoire, la prise en charge peropératoire et les paramètres postopératoires. Les facteurs de risque associés à l’hématome post-EAC avec P < 0,05 ont été introduits dans un modèle rétrospectif de régression logistique multifactorielle en paliers.
Résultats
Les dossiers de 249 patients ont été examinés et 29 cas d’hématome post-endartériectomie carotidienne ont été identifiés (incidence de 12 %). Six des 31 facteurs de risque potentiels désignés au début sont apparus comme des prédicteurs unifactoriels de la formation d’hématome post-EAC (P < 0,05): l’anesthésie générale, la mise en place d’un shunt carotidien, l’hypotension peropératoire, le non-renversement de l’héparine, le service de neurochirurgie et l’utilisation d’aspirine préopératoire. À la suite de la régression logistique, seules la non-inversion de l’héparine, l’hypotension peropératoire et la mise en place du shunt carotidien sont apparus comme des prédicteurs multifactoriels. Le temps passé à l’unité des soins intensifs (USI/salle de réveil) a été plus long (P < 0,01) pour le groupe présentant un hématome et la mortalité périopératoire était plus élevée (P = 0,04).
Conclusion
La formation d’un hématome post-EAC est associée à une morbidité et à une mortalité croissantes. Le non-renversement de l’héparine, l’hypotension peropératoire et la mise en place d’un shunt carotidien sont des prédicteurs multifactoriels de la formation d’un hématome post-EAC.
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Self, D.D., Bryson, G.L. & Sullivan, P.J. Risk factors for postcarotid endarterectomy hematoma formation. Can J Anesth 46, 635–640 (1999). https://doi.org/10.1007/BF03013950
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DOI: https://doi.org/10.1007/BF03013950