Clinical Implications of Marked Postoperative Blood Pressure Variability in Head and Neck Cancer Surgeries: A Retrospective Analysis.

Background: Prolonged major surgery for head and neck cancers presents challenges with potential implications for blood pressure fluctuations (BPF). This study aims to assess the incidence of significant BPF in such patients and explore its clinical associations. Methods: Ninety-eight patients underwent continuous BP monitoring during and after surgery. Demographic, clinical, echocardiographic, and laboratory data, including N-terminal pro-B-type natriuretic peptide (nt-pro BNP) levels, were analyzed. Multivariate analysis identified predictors of BPF. Results: Thirty-five percent (n=34) exhibited significant BPF (standard deviation ≥20) post-surgery. The BPF group showed associations with recurrent cancer, lower BMI, increased complications, and higher 30-day mortality. Elevated postoperative systolic BP, wider variability, and prolonged ICU and hospital stays were observed. While echocardiographic parameters showed no significant differences, increased postoperative nt-pro BNP levels suggested a potential link to heart failure in BPF cases. Conclusion: Extreme BPF in head and neck cancer surgery, particularly in recurrent cases, has significant clinical implications. The challenges in pharmacological management and patient care underscore the need for targeted interventions and vigilant monitoring. Given the elevated risk in this patient subset, implementing structured postoperative surveillance and tailored therapeutic strategies is essential to optimize outcomes and improve overall clinical care.