Document Type

Article

Publication Date

2-10-2025

Comments

This article is the authors' final version prior to publication in Journal of Neurosurgical Anesthesiology, Volume 37, Issue 4, October 2025, Pages 398-403.

The published version is available at https://doi.org/10.1097/ana.0000000000001031. Copyright © 2025, Wolters Kluwer Health.

Abstract

Background: Acute postoperative hypertension is commonly encountered in patients following craniotomy and is associated with major complications. The purpose of this retrospective cohort study was to evaluate 30-day survival for patients who received labetalol, nicardipine, or both for hypertension after craniotomy.

Methods: Patients 18 and older who underwent craniotomy between January 1, 2010 and January 1, 2023 were included in the study. Three separate analyses were performed comparing each group: 1) labetalol cohort versus nicardipine cohort, 2) labetalol cohort versus both cohort, and 3) nicardipine cohort versus both cohort. The primary outcome was survival at 30 days. Secondary outcomes included 30-day readmission, ST-elevation myocardial infarction, congestive heart failure, non-ST elevation myocardial infarction, arrhythmia, and intracranial hemorrhage.

Results: The labetalol cohort had improved 30-day survival compared to the cohort receiving nicardipine (HR: 0.49, p < 0.0001) or both (HR: 0.67, p < 0.0001). The nicardipine cohort had worse survival compared to patients who received both drugs (HR: 1.28 p < 0.0001). The labetalol cohort had lower risk of intracranial hemorrhage compared to the nicardipine (RR: 0.89, p = 0.001) and combination cohorts (RR: 0.90, p < 0.001). Patients who received labetalol had less risk of congestive heart failure than those who received nicardipine (RR 0.66, p < 0.0001), and those who received nicardipine alone had a higher risk of CHF than those who received a combination (RR: 1.21, p = 0.018). There was no difference in risk of STEMI, NSTEMI, or readmissions across any comparisons.

Conclusions:  Patients who received labetalol for APH after craniotomy had improved survival at 30 days compared to patients receiving nicardipine or both drugs. Patients who received both drugs also had improved survival compared to patients who received only nicardipine.

Language

English

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