The impact of intraoperative blood pressure levels on postoperative bleeding in common breast surgery procedures - a case-control study

Background: Breast surgery, ranging from aesthetic adjustments to oncological reconstructions, has seen a significant rise in recent years, with over 4.3 million procedures globally in 2022. However, they pose risks like postoperative bleeding and hematoma, impacting patient recovery and morbidity. Identifying and mitigating risk factors is crucial for better postoperative outcomes. The effect of blood pressure at the wound closure start on postoperative bleeding complications is a key research area, with current studies showing inconsistent findings. This research gap necessitates further investigation to optimize outcomes in breast surgery. Methods: For this retrospective case-control study, data from 2007 to 2021 were collected from the Caritas Hospital St. Josef database in Regensburg. Patients undergoing subcutaneous mastectomy, breast reduction or reconstruction were identified. Perioperative variables, including demographics, health status, blood pressure and postoperative complications, were analyzed. Statistical analysis was performed using SPSS, matching cases and controls at a 1:4 ratio. Results: A total of 41 patients with postoperative hemorrhage were matched to 164 controls. The primary finding was a significant link between lower systolic blood pressure at wound closure and increased hemorrhage risk, with no other demographic or medical factors (age, BMI, hypertension or bleeding disorders) showing a significant association. Conclusions: Our study suggests that a low intraoperative blood pressure at the wound closure start is a key risk factor for postoperative hemorrhage in breast surgery. Strict blood pressure control during surgery could reduce bleeding risk after breast surgery procedures. Further research is needed to optimize the perioperative workflow regarding blood pressure settings.