Intraoperative Blood Pressure and Hemorrhagic Complications after Brain Tumor Biopsies: An Observational Study Using a Propensity Score-matched Analysis.

Abstract

Brain tumor biopsies are essential for pathological diagnosis. However, hemorrhagic complications after biopsies may occur, leading to suboptimal outcomes. This study evaluated the relationship between intraoperative blood pressure, especially anesthesia awakening, and hemorrhagic complications after brain tumor biopsies. We retrospectively collected data on consecutive patients with brain tumors (malignant lymphoma or glioma) who underwent a biopsy from 2011 to 2020. During the first half of the study period (until 2015), we managed patients with a mild blood pressure-lowering policy during awakening from general anesthesia, while in the latter half (after 2016), we aggressively lowered blood pressure below 140 mmHg. This blood pressure management was performed as a best practice. After propensity score matching using logistic regression analysis, 122 patients were included. With the aggressive blood pressure-lowering policy, the values of blood pressure-related parameters during the recovery from general anesthesia were drastically reduced (median maximum blood pressures were 165 [mmHg] until 2015 vs. 135 after 2016, p < 0.001). Accordingly, the overall bleeding rate decreased after 2016 (ALL bleeding, 54.1 vs. 31.1%, p = 0.017; symptomatic bleeding, 16.4% vs. 6.6%, p = 0.154). Abrupt blood pressure rise during anesthesia awakening (mmHg/min) was significantly associated with symptomatic postsurgical hemorrhages (p = 0.012). An aggressive blood pressure-lowering policy reduced blood pressure during recovery from general anesthesia and the overall bleeding rates. Avoiding rapid blood pressure rises during anesthesia awakening may be necessary by focusing on both blood pressure and the speed of any changes.