Post-Operative Blood Pressure Goals Following Craniotomy for Tumor Resection - A National Survey

Introduction: Hypertension can occur in 90% of patients after a craniotomy for tumor resection, with 60 – 90% requiring treatment with antihypertensive agents. Postoperative intracranial hemorrhage (ICH) is a feared complication after craniotomy for tumor resection, and perioperative hypertension is believed to be a risk factor. Many neurosurgeons impose post-operative blood pressure goals to mitigate this risk, but without evidence to support a particular goal there is likely wide variation in patient care. Here, we have conducted a national survey to report the current practices regarding postoperative blood pressure management.

Methods: We conducted a cross-sectional survey of academic neurosurgical programs by distributing a 10-item questionnaire to neurosurgical residents of each accredited neurosurgical residency training program. Responses were collected over three months, and the survey was closed in September 2023. Analysis was performed at the program level; for programs with multiple responding residents, the responses of the senior residents were retained. Descriptive statistics are provided.

Results: Survey links were distributed to coordinators at 117 residency programs. Responses were received from sixty-six residents at forty-five institutions. Forty-two programs set postoperative blood pressure goals using Systolic Blood Pressure (SBP) as a parameter, and two used Mean Arterial Pressure (MAP). Among programs using an SBP goal, most programs kept a goal SBP < 140 mmHg (41 – 43% depending on tumor type), followed by SBP < 160 mmHg (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 blood pressure goals.

Conclusion : The vast majority of academic neurosurgical programs utilize a postoperative SBP goal following craniotomy for tumor resection. Programs are nearly evenly divided between goals of SBP < 140mmHg or SBP < 160mmHg. The variability among programs indicates clinical equipoise between these two approaches in the context of a future clinical trial.