Association of Preoperative Blood Pressure With 30-Day Mortality in Patients Undergoing Craniotomy for Brain Tumor Excision: A Retrospective Database Analysis

BACKGROUND: The association between preoperative blood pressure and 30-day postoperative mortality in patients undergoing craniotomy for brain tumors remains unclear. This study aims to investigate this relationship and to identify specific blood pressure thresholds that may increase the risk of 30-day postoperative mortality. METHODS: This retrospective cohort study analyzed electronic health records of adults who underwent brain tumor craniotomy at West China Hospital, Sichuan University, between January 2011 and March 2021. Preoperative blood pressure parameters-systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP)-were collected. Adjusted multivariable logistic regression models with restricted cubic splines were developed to assess 30-day mortality. RESULTS: A total of 12,643 patients were included, with a 30-day mortality of 1.8% (233/12,643). Both low and high preoperative blood pressure were linked to increased 30-day mortality, with U-shaped relationships observed for SBP, DBP, MAP, and PP. Compared with reference ranges (SBP: 120 to 140 mm Hg, DBP: 70 to 80 mm Hg, MAP: 90 to 110 mm Hg, and PP: 45 to 65 mm Hg), the strongest associations occurred at SBP ≥160 mm Hg (adjusted OR: 2.85, 95% CI: 1.44-5.67), DBP ≥100 mm Hg (OR 2.73, 95% CI: 1.52-4.93), MAP ≥130 mm Hg (OR 4.80, 95% CI: 1.66-13.94), and PP ≥85 mm Hg (OR 4.50, 95% CI: 1.52-13.29). CONCLUSIONS: Both low and high preoperative blood pressure were associated with increased 30-day mortality, demonstrating U-shaped relationships across all blood pressure parameters. Prospective studies are needed to test whether modification of preoperative blood pressure changes risk.