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Risk factors for post-carotid endarterectomy hematoma formation
D D Self1, G L Bryson, P J Sullivan
1Department of Anesthesiology, The Ottawa Hospital - Civic Campus, Ontario, Canada.
Insights
Post-carotid endarterectomy (CEA) hematoma formation, occurring in 12% of patients, is linked to increased mortality. Key risk factors include non-reversal of heparin, intraoperative hypotension, and carotid shunt placement.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Patient Safety
Background:
- Carotid endarterectomy (CEA) is a common procedure to prevent stroke.
- Hematoma formation is a significant post-operative complication following CEA.
- Identifying risk factors for hematoma is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of post-carotid endarterectomy (CEA) hematoma.
- To identify independent risk factors associated with post-CEA hematoma formation.
Main Methods:
- A case-control study was conducted using chart review of CEA patients.
- 31 potential risk factors were assessed for association with hematoma.
- Logistic regression analysis was employed to identify multivariate predictors.
Main Results:
- The incidence of post-CEA hematoma was 12% (29 cases out of 249 patients).
- Univariate predictors included general anesthesia, shunt placement, hypotension, non-reversal of heparin, neurosurgery service, and aspirin use.
- Multivariate predictors of hematoma were non-reversal of heparin, intraoperative hypotension, and carotid shunt placement.
Conclusions:
- Post-CEA hematoma is associated with increased morbidity and mortality.
- Non-reversal of heparin, intraoperative hypotension, and carotid shunt placement are significant predictors of hematoma formation.
- These findings can inform strategies to mitigate hematoma risk in CEA patients.
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 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.