World neurosurgery · 2026
Intraoperative Mean Arterial Pressure and Postoperative Deep Vein Thrombosis in Patients Undergoing Craniotomy for Presumed High-Grade Glioma Resection: A Secondary Analysis of a Randomized Controlled Trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Li Guoming, Zheng Maoyao, Zhang Xingyue, Yin Xueke, Li Shu, Liu Xiaoyuan, Peng Yuming
Аннотация
INTRODUCTION: Patients with malignant brain tumors exhibit a hypercoagulable state. The risk of postoperative deep venous thrombosis (DVT) is elevated. The association between intraoperative blood pressure and postoperative DVT in this population remains poorly defined.
METHODS: This secondary analysis included adults undergoing elective craniotomy for presumed high-grade glioma from a randomized, double-blind, placebo-controlled trial. Intraoperative mean arterial pressure (MAP) was recorded invasively at 10-second intervals. Hypotension exposure was quantified as cumulative duration, area under the curve, and time-weighted average below absolute thresholds (65, 70, 75 mm Hg) and relative thresholds (20%, 30%, 40% decrease from baseline). Baseline imbalances were assessed using absolute standardized differences, with a prespecified threshold of 0.32 derived from preanalysis adaptation to this neurosurgical cohort. Variables exceeding this threshold guided multivariable model construction. A 1:4 propensity score-matched sensitivity analysis was performed with conditional logistic regression.
RESULTS: Among 480 patients, 41 (8.5%) developed postoperative lower-extremity DVT. One patient had confirmed pulmonary embolism. Fifteen baseline variables exceeded the prespecified absolute standardized difference threshold of 0.32. After adjustment for 9 covariates in the expanded multivariable model, midline shift (adjusted odds ratio [aOR] 4.01, 95% confidence interval [CI] 1.59-10.13, P = 0.003) and surgery duration ≥5 hours (aOR 2.96, 95% CI 1.40-6.27, P = 0.004) remained independent risk factors. Cumulative duration below MAP 75 mm Hg remained associated with DVT after comprehensive adjustment (aOR per 10-minute increase 1.029, 95% CI 1.001-1.057, P = 0.041). In the 1:4 propensity-matched cohort (n = 205), this association persisted with an OR of 1.22 per 30-minute increase (95% CI 1.07-1.39, P = 0.003).
CONCLUSIONS: In patients undergoing craniotomy for presumed high-grade glioma, cumulative intraoperative hypotension below a MAP threshold of 75 mm Hg is associated with postoperative DVT after rigorous confounder adjustment and propensity matching. These observational findings support consideration of MAP maintenance ≥75 mm Hg in this high-risk population. Prospective validation is required.
METHODS: This secondary analysis included adults undergoing elective craniotomy for presumed high-grade glioma from a randomized, double-blind, placebo-controlled trial. Intraoperative mean arterial pressure (MAP) was recorded invasively at 10-second intervals. Hypotension exposure was quantified as cumulative duration, area under the curve, and time-weighted average below absolute thresholds (65, 70, 75 mm Hg) and relative thresholds (20%, 30%, 40% decrease from baseline). Baseline imbalances were assessed using absolute standardized differences, with a prespecified threshold of 0.32 derived from preanalysis adaptation to this neurosurgical cohort. Variables exceeding this threshold guided multivariable model construction. A 1:4 propensity score-matched sensitivity analysis was performed with conditional logistic regression.
RESULTS: Among 480 patients, 41 (8.5%) developed postoperative lower-extremity DVT. One patient had confirmed pulmonary embolism. Fifteen baseline variables exceeded the prespecified absolute standardized difference threshold of 0.32. After adjustment for 9 covariates in the expanded multivariable model, midline shift (adjusted odds ratio [aOR] 4.01, 95% confidence interval [CI] 1.59-10.13, P = 0.003) and surgery duration ≥5 hours (aOR 2.96, 95% CI 1.40-6.27, P = 0.004) remained independent risk factors. Cumulative duration below MAP 75 mm Hg remained associated with DVT after comprehensive adjustment (aOR per 10-minute increase 1.029, 95% CI 1.001-1.057, P = 0.041). In the 1:4 propensity-matched cohort (n = 205), this association persisted with an OR of 1.22 per 30-minute increase (95% CI 1.07-1.39, P = 0.003).
CONCLUSIONS: In patients undergoing craniotomy for presumed high-grade glioma, cumulative intraoperative hypotension below a MAP threshold of 75 mm Hg is associated with postoperative DVT after rigorous confounder adjustment and propensity matching. These observational findings support consideration of MAP maintenance ≥75 mm Hg in this high-risk population. Prospective validation is required.