SURG-16. Impact of postoperative blood pressure management on postoperative hemorrhage after resection of intraparenchymal brain tumors

Abstract PURPOSE Postoperative hemorrhage is a serious complication following elective craniotomy for intraparenchymal brain tumors and can significantly impair neurological outcomes. Elevated postoperative blood pressure is a known risk factor. This study aimed to evaluate the relationship between blood pressure and other clinical or radiological factors in relation to postoperative hemorrhage. MATERIALS AND METHODS We retrospectively analyzed all patients who underwent surgery for intraparenchymal brain tumors at our institution between 2016 and 2023. Intraoperative and postoperative blood pressure, as well as heart rate during the first 12 postoperative hours, were recorded. Patients who developed postoperative hemorrhage requiring surgical revision or intravenous antihypertensive therapy were compared with those without complications. ROC analysis was performed to identify blood pressure thresholds associated with increased risk. RESULTS A total of 453 patients (median age: 59 years) were included. Postoperative hemorrhage requiring intervention occurred in 35 patients (7.7%); 9 required surgical revision, and 26 were treated conservatively. Male sex (p = 0.008), pre-existing hypertension (p = 0.039), and residual tumor volume (p = 0.031) were significantly associated with hemorrhage. Both intraoperative (p < 0.05) and postoperative (p < 0.001) systolic blood pressure were strongly correlated with hemorrhage risk. ROC analysis identified a threshold of 140 mmHg systolic pressure. Patients with hemorrhage had significantly longer durations of elevated systolic pressure (>140 mmHg for 62 minutes, >160 mmHg for 17 minutes). Hemorrhage requiring revision surgery in the context of mass effect was associated with worse overall survival (p = 0.004). No significant differences were observed in postoperative ischemia between groups. CONCLUSION Postoperative systolic blood pressure should be strictly controlled below 140 mmHg following craniotomy for intraparenchymal tumors. Sustained elevations significantly increase the risk of hemorrhage and may impact overall survival.