Association Between Postoperative Hypotension and Mortality and Complications in Patients Undergoing Craniotomy for...

Postoperative hypotension is a common modifiable risk factor linked to adverse outcomes. However, the association between postoperative hypotension and mortality in brain tumor resection patients is still unclear. This study aims to explore the association between postoperative hypotension and mortality, and to identify the critical blood pressure thresholds for managing postoperative care in this patient group.

We conducted a retrospective cohort study on patients who had craniotomy for brain tumors at West China Hospital, Sichuan University, from January 1, 2011, to May 31, 2024. Postoperative blood pressure was categorized by the lowest mean arterial pressure (MAP) within 72 hours after surgery, using 5-mm Hg intervals (≤50, 50-55, 55-60, 60-65, 65-70, 70-75, 75-80, >80 mm Hg). The outcome was postoperative morbidity.

This study included 23 680 patients who underwent craniotomy for brain tumors, with 558 (2.4%) experiencing 30-day mortality. The findings showed that postoperative hypotension is associated with increased mortality, with an L-shaped relationship for the lowest MAP. Specifically, compared with the reference group (MAP 60-65 mm Hg), the adjusted odds ratios (OR) for 30-day mortality were MAP ≤50 mm Hg (OR 8.96, 95% CI: 5.92-13.54), MAP 50 to 55 mm Hg (OR 2.43, 95% CI: 1.42-4.15), and MAP 55 to 60 mm Hg (OR 2.15, 95% CI: 1.51-3.07). No significant differences were found in higher MAP ranges. In addition, postoperative hypotension was associated with acute kidney injury, myocardial infarction, hospital-acquired infection, pneumonia, intracranial infection, bloodstream infection, urinary tract infection, and deep vein thrombosis. No significant differences were found in blood pressure variability metrics between the survival and 30-day mortality groups.

Postoperative hypotension was independently associated with an increased risk of increased mortality and complications in brain tumor craniotomy. An L-shaped relationship was observed between postoperative MAP and mortality risk, with a marked inflection point at 65 mm Hg.