Evaluation of the Safety of Liberalized Systolic Blood Pressure Goals in the Postoperative Period Following Intracranial Tumor Resection

Saturday, May 4, 2024

4:56 PM – 5:00 PM CT

Location: N427bc

Presenting Author(s)

Sabrina L. Zeller, MD

Neurosurgery Resident
Westchester Medical Center
Valhalla, NY, US

Co-Author(s)

FA

Fawaz Al-Mufti, MD

Associate Professor
Westchester Medical Center, New York, United States
SH

Simon J. Hanft, MD

Section Chief, Neurosurgical Oncology
Westchester Medical Center
Pleasantville, New York, United States
Sauson Soldozy, MD

Neurosurgery Resident
Westchester Medical Center
Valhalla, NY, US
GS

Galadu Subah, n/a

Medical Student
New York Medical College, United States
SV

Sima Vazquez, MS

Medical Student
New York Medical College, United States

Disclosure(s):

Sabrina L. Zeller, MD: No financial relationships to disclose

Introduction: Postoperative intracranial hemorrhage (POH) is a serious neurosurgical complication occurring in approximately 1.4% of patients following intracranial tumor resection. The convention across the United States is to target immediate postoperative systolic blood pressure (SBP) under 140 mmHg to minimize this risk; however, this SBP goal lacks support in literature despite widespread adoption. This study aims to investigate the safety and benefits of SBP liberalization to 160 mmHg.

Methods: A retrospective review was conducted on consecutive patients, aged 18 to 75 years, undergoing craniotomy for intracranial tumor resection by a single neurosurgeon from October 2020 until June 2023. Data was gathered from the electronic medical record in accordance with Institutional Review Board guidelines regarding patient demographics, operative details, perioperative vital signs, resource utilization, and complications. POH was defined as symptomatic hemorrhage within 48 hours requiring intervention.

Results: The study included 147 patients, with 104 patients in the experimental cohort (SBP < 160) and 43 patients in the control (SBP < 140). The average age was 54.5 ± 14.9 years and 57.6 ± 10.6 years in the experimental and control groups, respectively (p = 0.23). Intensive care unit (ICU) length of stay (LOS) was significantly lower in the experimental group, 1.9 ± 1.9 days, compared to control, 3.1 ± 5.8 days (p = 0.05). The experimental group utilized $12.13 ± $41.14 on as needed antihypertensive medications versus $16.42 ± $31.13 in the control (p = 0.28), with significantly lower labetalol (p = 0.04). There were no POH in either cohort.

Conclusion : Standardized liberalization of SBP goals to under 160 mmHg is safe in the immediate postoperative period after craniotomy for tumor resection without increased risk of POH. Less strict SBP goals allow for shortened ICU LOS and possibly reduced usage of antihypertensive medications.