Intraoperative Hypotension and Postoperative Newly Developed Cerebral Infarction in Patients With Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study

ABSTRACT Aims To investigate the association between intraoperative hypotension and newly developed cerebral infarction in patients with aneurysmal subarachnoid hemorrhage (aSAH) undergoing aneurysm clipping or coiling. Methods The patients who had emergent clipping/coiling procedures for aSAH under general anesthesia were included. The major exposure was mean arterial pressure (MAP) below different absolute or relative thresholds characterized by area under curve (AUC), duration, and time‐weighted average (TWA) value. The outcome was newly developed cerebral infarction. The associations between MAP and newly developed cerebral infarction were adjusted by other risk factors. Odds ratio and 95% confidence interval were used to present the statistical difference. Results A total of 1205 patients were included in the analysis. Of these, 260 patients (21.6%) developed new cerebral infarctions assessed by computed tomography. Patients with newly developed cerebral infarction had higher incidence of modified Fisher Scale (mFS) score 3 to 4 (80.0 vs. 69.1%, p < 0.01) and longer duration of anesthesia (4.3 vs. 3.9 h, p < 0.01). In the multivariate model, the AUC‐MAP (adjusted odds ratio: 1.00, 95% CI: 1.000 to 1.000, p = 0.02) and the TWA‐MAP (adjusted odds ratio: 1.01, 95% CI: 1.001 to 1.024, p = 0.04) of 20% decrease from baseline were closely associated with the newly developed cerebral infarction. Conclusions Mean arterial pressure decreased 20% from baseline value were independently associated with postoperative newly developed cerebral infarction in patients with aSAH.