Background: The association between intraoperative hypotension and delirium in patients with brain tumors remains unclear. We thus evaluated the association between intraoperative hypotension and postoperative delirium in patients recovering from neurological surgery. Methods: This was a secondary analysis of 3 prospective studies. Patients aged greater than 18 years who were scheduled for elective craniotomy for resection of glioma or frontotemporal lobe tumor were enrolled. Intraoperative hypotension was quantified through 3 metrics: mean arterial pressure area under the curve, time-weighted mean arterial pressure, and cumulative duration of hypotension. Our primary outcome was the association between hypotension and postoperative delirium. Results: The study comprised 738 patients (median age 56 y; 50% male) undergoing craniotomy for brain tumor resection. Postoperative delirium occurred in 29.0% (95% CI: 25.7%-32.3%) of patients. No statistically significant associations between intraoperative hypotension (absolute mean arterial pressure 60 to 75 mm Hg, relative reductions 10% to 40% from baseline) and postoperative delirium. However, the presence of preoperative tumor midline shift was an independent risk factor for postoperative delirium (adjusted odds ratio: 1.56, 95% CI: 1.09-2.22, P =0.014), and interacted with time-weighted average mean arterial pressure at relative reductions 10% based on the subgroup analysis. Conclusions: In adult patients undergoing elective craniotomy for tumor resection, no significant association is found between intraoperative hypotension and postoperative delirium.
Cui et al. (2026) studied this question.