Postoperative Blood Pressure Goals After Craniotomy for Tumor Resection: A National Survey

Acute hypertension can occur in 90% of postcraniotomy patients for tumor resection, and 60% to 90% of patients require treatment with antihypertensive agents. Postoperative intracranial hemorrhage is a major driver of morbidity and mortality after craniotomy for tumor resection, and perioperative hypertension is believed to be a risk factor. Many neurosurgeons impose postoperative blood pressure (BP) goals to mitigate this risk, but there is little evidence to guide the selection of a specific target BP, leading to a wide variation in patient care. In this article, we have conducted a national survey to report the current practices regarding postoperative BP management.

We conducted a cross-sectional survey of academic neurosurgical programs by distributing a 10-item questionnaire to neurosurgical residents of each accredited national neurosurgical residency training program (n = 117). Responses were collected over 3 months, from July 2023 to September 2023. Analysis was performed at the program level; for programs with multiple responding residents, the responses of the senior residents were retained.

Responses were received from 66 residents at 45 institutions. Forty-two programs set postoperative BP goals using systolic blood pressure (SBP) as a parameter, and 2 used mean arterial pressure. Among programs using an SBP goal, most programs kept a goal SBP of <140 mm Hg (41%-43% depending on the tumor type), followed by SBP <160 mm Hg (36%-39%). Most programs maintained this goal until the morning of the first postoperative day. Intravenous nicardipine (n = 12, 27%) and labetalol (n = 12, 27%) were the most frequently administered medications to maintain BP goals.

Most of the academic neurosurgical programs use a postoperative SBP goal after craniotomy for tumor resection. Programs are evenly divided between goals of SBP <140 mm Hg and SBP <160 mm Hg. The variability among programs indicates clinical equipoise between these 2 approaches in the context of a future clinical trial.