Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery

Abstract

<b>Background</b> Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. <b>Materials and Methods</b> During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20-50%), Group C (>50-100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. <b>Results</b> The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender ( <i>p</i> < 0.001), hypertension ( <i>p</i> = 0.008), tumor size >5 cm ( <i>p</i> < 0.001), high-grade glioma ( <i>p</i> = 0.004), meningioma ( <i>p</i> < 0.001), mass effect ( <i>p</i> = 0.002), midline shift ( <i>p</i> = 0.014), highly vascular tumors documented on preoperative imaging ( <i>p</i> < 0.001), extended craniotomy approach ( <i>p</i> = 0.002), intraoperative colloids use >1,000 mL ( <i>p</i> < 0.001), intraoperative brain bulge ( <i>p</i> = 0.03), intraoperative appearance as highly vascular tumor ( <i>p</i> < 0.001), and duration of surgery >300 minutes ( <i>p</i> < 0.001). <b>Conclusions</b> Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.