Relationship between intraoperative hypertension and postoperative ischemic stroke in neurosurgery-a retrospective cohort study.

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.