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Relationship between intraoperative hypertension and postoperative ischemic stroke in neurosurgery-a retrospective
Yu-Mei Feng1, Qian-Yun Pang1, Ya-Jun Yang1
1Department of Anesthesiology, Chongqing University Cancer Hospital, Hanyu Road No. 181, Shapingba District, Chongqing City, 400030, China.
Insights
Intraoperative hypertension is a significant predictor of postoperative ischemic stroke in neurosurgery. Managing blood pressure during surgery, particularly peak values, duration, and area under the curve, is crucial for reducing stroke risk.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Postoperative ischemic stroke is a serious complication following neurosurgery.
- Intraoperative hypertension is a common occurrence during these procedures.
- The relationship between intraoperative hypertension and postoperative stroke risk is not well-established.
Purpose of the Study:
- To investigate the association between intraoperative hypertension and postoperative ischemic stroke in patients undergoing brain tumor craniotomies.
- To identify specific indices of intraoperative hypertension that predict stroke risk.
Main Methods:
- Retrospective cohort study of 1,786 patients undergoing craniotomies.
- Defined intraoperative hypertension using mean arterial pressure (MAP) > 105 mmHg, analyzing peak MAP, duration, and area under the curve (AUC).
- Multivariate logistic regression and restricted cubic spline analysis were used to identify risk factors and assess stroke risk thresholds.
Main Results:
- Intraoperative hypertension, older age, and higher intraoperative crystalloid infusion rates were identified as risk factors for postoperative ischemic stroke.
- Specific risk thresholds for intraoperative hypertension included peak value > 123 mmHg, duration > 5 minutes, and AUC > 530 mmHg*min.
- Despite these associations, the abstract states intraoperative hypertension was not significantly associated with postoperative stroke risk, which contradicts the previous findings. This requires clarification.
Conclusions:
- Intraoperative hypertension is a significant predictor of postoperative ischemic stroke in neurosurgical patients.
- Peak blood pressure, duration of hypertension, and AUC demonstrate independent predictive value for stroke risk.
- Close monitoring and management of intraoperative blood pressure are essential to mitigate stroke risk in neurosurgical procedures.
Background:
Postoperative ischemic stroke is a severe complication in neurosurgery, while intraoperative hypertension is a frequent event. However, their clinical relationship remains poorly understood.
Methods:
This retrospective cohort study analyzed data from patients with brain tumors undergoing craniotomies between January 2017 and December 2023 at Chongqing University Cancer Hospital. Multivariate logistic regression identified risk factors for postoperative stroke. Intraoperative hypertension was defined as a mean arterial pressure (MAP) > 105 mmHg, with indices including peak MAP, duration, and area under the curve (AUC). Restricted cubic spline analysis with three knots (10th, 50th, and 90th percentiles) was performed. The outcome was postoperative in-hospital acute ischemic stroke. The risk of stroke was assessed by quartile categorization of hypertension indices.
Results:
A total of 1,786 patients were included in the final analysis. Intraoperative hypertension was identified as a risk factor for postoperative ischemic stroke, alongside age and intraoperative crystalloid infusion rate. Quatile analysis revealed the following risk thresholds of intraoperative hypertension: 1) peak value > 123 mmHg (aOR: 2.118, 95% CI: 1.360-3.297); 2) duration > 5 min (aOR: 1.604, 95% CI: 1.033-2.491); 3) AUC > 530 mmHg*min (aOR: 1.811, 95% CI: 1.165-2.816). Intraoperative hypertension was not significantly associated with postoperative stroke risk.
Conclusion:
Intraoperative hypertension is a significant predictor of postoperative ischemic stroke in neurosurgical patients, with peak value, the duration, and AUC all demonstrating independent predictive values. These findings underscore the critical need for vigilant intraoperative blood pressure monitoring and management to mitigate stroke risk in neurosurgical patients.
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