Baseline Blood Pressure Data Availability in Cervical Spine Decompression Surgery
While baseline blood pressure measurements are critical for perioperative management and should be obtained preoperatively, the available evidence does not directly address whether most patients actually have well-defined baseline data documented at the time they present for cervical spine decompression surgery.
What the Guidelines Require
The Perioperative Quality Initiative consensus statement explicitly recommends that patient-specific postoperative blood pressure target ranges must be created based on baseline preoperative blood pressure measurements and clinical context 1. This guideline emphasizes that:
- Baseline blood pressure should be assessed on a case-by-case basis before surgery 1, 2
- For patients with abnormal baseline values (systolic pressure >140 or <100 mmHg), postoperative targets must be adapted accordingly 1
- Intraoperative systolic pressures >70% of preoperative baseline are associated with less harm 1
Special Considerations for Cervical Spine Surgery
For high-risk patients undergoing cervical spine procedures (prolonged duration, substantial blood loss), the American Society of Anesthesiologists recommends:
- Continuous monitoring of systemic blood pressure throughout the perioperative period 1
- Checking for pre-operative hypertension, its degree of control, pre-operative use of anti-hypertensive drugs, and the patient's risk of end-organ damage 1, 2
- Maintaining arterial pressure at higher levels in hypertensive patients (approximately 70-75% of preoperative baseline at minimum) to prevent end-organ damage 2
The Reality Gap
The critical caveat is that while guidelines mandate obtaining baseline blood pressure data, none of the provided evidence documents what percentage of patients actually have well-defined baseline measurements available in practice. The research studies examining blood pressure changes after cervical decompression surgery 3, 4, 5, 6 measured blood pressure as part of their protocols but do not report on the baseline availability of such data in routine clinical practice.
Clinical Implications
Given the high prevalence of hypertension in cervical spondylotic myelopathy patients (46.6-56.4% in research cohorts) 4, 6, and the requirement for baseline measurements to guide perioperative management 1, clinicians must proactively obtain preoperative blood pressure measurements if not already documented. This is particularly important because:
- Trigger values for postoperative hypotension are calculated as <75% of baseline 1
- Trigger values for postoperative hypertension are calculated as >140% of baseline 1
- Without baseline data, these individualized targets cannot be established 1, 2
In the absence of documented baseline blood pressure, default to maintaining systolic pressure >90 and <160 mmHg for patients presumed to have normal baseline blood pressure, but recognize this is suboptimal compared to individualized targets 1.