Relation between perioperative hypertension and intracranial hemorrhage after craniotomy

Background: Previous data suggest that systemic hypertension (HTN) is a ris k factor for postcraniotomy intracranial hemorrhage (ICH). The authors exam ined the relation between perioperative blood pressure elevation and postop erative ICH using a retrospective case control design. Methods: The hospital's database of all patients undergoing craniotomy from 1976 to 1992 was screened, Coagulopathic and unmatchable patients were exc luded. There were 69 evaluable patients who developed ICH postoperatively ( n = 69). A 2-to-1 matched (by age, date of surgery, pathologic diagnosis, s urgical procedure, and surgeon) control group without postoperative rca was assembled (n = 138). Preoperative, intraoperative, and postoperative blood pressure records (up to 12 h) were examined. Incidence of perioperative HT N (blood pressure greater than or equal to 160/90 mmHg) and odds ratios for ICH were determined. Results: Of the 11,214 craniotomy patients, 86 (0.77%) suffered ICH, and 69 fulfilled inclusion criteria. The incidence of preoperative HTN was simila r in the ICH (34%) and the control (24%) groups. ICH occurred 21 h (median) postoperatively, with an interquartile range of 4-52 h. Sixty-two percent of ICH patients had intraoperative HTN, compared with only 34% of controls (P < 0.001). Sixty-two percent of the ICH patients had prehemorrhage Hm in the initial 12 postoperative hours versus 25% of controls (P < 0.001), with an odds ratio of 4.6 (P < 0.001) for postoperative ICH. Hospital stay (med ian, 24.5 vs. 11.0 days), and mortality (18.2 vs. 1.6%) were significantly greater in the ICE than in the control groups. Conclusions: ICH after craniotomy is associated with severely prolonged hos pital stay and mortality. Acute blood pressure elevations occur frequently prior to postcraniotomy ICH. Patients who develop postcraniotomy ICH are mo re likely to be hypertensive in the intraoperative and early postoperative periods.