# Predictors of Postoperative Bleeding After Cranial Surgery: The Role of Perioperative and Tumor-Related Factors

## TL;DR

This study identifies factors like intraoperative blood loss and hospital stay that increase the risk of postoperative bleeding after brain tumor surgery.

## Contribution

The study reveals new clinical predictors of postoperative bleeding in cranial tumor surgery, focusing on perioperative variables.

## Key findings

- Intraoperative blood loss is significantly associated with postoperative hemorrhage.
- Prolonged hospitalization and worse functional outcomes are linked to postoperative bleeding.
- Tumor-specific characteristics and lab values do not significantly predict bleeding.

## Abstract

Postoperative hemorrhage after cranial tumor surgery represents a serious complication with potentially profound effects on neurological function, recovery, and overall clinical outcome. To advance the understanding of clinical determinants and patient-specific characteristics that may increase the risk of such adverse events, we performed a retrospective evaluation of more than 1800 neuro-oncological patients treated in our department. Analysis of the collected data allowed us to identify clinically relevant associations to hemorrhage and tumor-associated factors that contribute to the development of this major surgical complication.

Postoperative hemorrhage (POH) is a rare but serious complication of cranial neurosurgery, often resulting in neurological deterioration and necessitating urgent surgical intervention. Despite its clinical relevance, POH remains underreported and insufficiently understood. This study aimed to identify potential risk factors including perioperative variables and tumor-related characteristics associated with POH requiring surgical evacuation. A total of 1862 cranial tumor procedures were performed in our department over a 10-year period. Data on perioperative parameters and tumor characteristics were retrospectively collected and analyzed. Statistical analyses were conducted to assess associations of them to POH. Statistical analysis revealed several peri- and postoperative variables significantly associated with POH in univariate analyses. These included intraoperative blood loss (p = 0.012) and length of postoperative hospital stay (p = 0.016). Furthermore, the outcomes measured using the Glasgow Outcome Scale (p < 0.001) and the Karnofsky Performance Scale (p < 0.001) showed also statistical relevance as a result of postoperative bleeding in these patients. The findings suggest that specific perioperative factors particularly intraoperative blood loss are associated with an increased risk of POH after intracranial tumor surgery. Additionally, prolonged hospitalization and worsened functional outcomes were linked to the occurrence of postoperative hemorrhage. In contrast, tumor-specific characteristics and routine laboratory values showed no significant association with hemorrhagic complications in this cohort.