Outcomes of Revascularized Acute Mesenteric Ischemia in the American College of Surgeons National Surgical Quality Improvement Program Database

Abstract

This report examines outcomes of revascularization for acute arterial mesenteric ischemia (AAMI) using the American College of Surgeons National Surgical Quality Improvement Program database. Patients with International Classification of Diseases, 9th Revision and Current Procedural Terminology codes indicating AAMI with concomitant mesenteric revascularization were identified. Demographic, risk factor, procedural, morbidity, and mortality data were examined. Associations with morbidity and mortality were analyzed by logistic regression. One hundred forty-two cases of AAMI were identified. Seventy-one cases were thrombotic and 71 were embolic according to revascularization codes. Mean age was 66 years, 84 per cent of patients were white, and 54 per cent were female. Unadjusted major morbidity and mortality rates were 69 and 30 per cent, respectively. Patients with thrombotic AAMI were more likely to have a lower body mass index, greater than 10 per cent weight loss in the past 6 months, and a history of smoking. Patients with embolic AAMI were more likely to present emergently with sepsis. Unadjusted morbidity and mortality rates were 78 and 38 per cent for embolic and 61 and 23 per cent for thrombotic AAMI, respectively. Multi-variable predictors of morbidity included bowel resection at the time of revascularization, transfer admission, and involvement of a surgical resident. Multivariable predictors of mortality included impaired functional status, increased age, and postoperative sepsis. Cause of AAMI was not a significant predictor of morbidity or mortality. In a large sample of AAMI cases, AAMI remained a highly lethal and morbid condition. Predictors of morbidity and mortality included indicators of advanced presentation, treatment delay, and patient-related factors specific to AAMI, including debility and advanced age. Efforts directed at prevention and increasing the speed of diagnosis and definitive treatment appear to be necessary to improve outcomes.

Early Endovascular Treatment of Superior Mesenteric Occlusion Secondary to Thromboemboli

“…1,6 Early diagnosis and immediate treatment are the most important factors in the attempt to reverse ischemia in the intestine. 7,10 Our study demonstrates that early endovascular therapy can lead to improved outcomes in patients with this condition, with 30-day mortality of 9.5%.…”

“…1e5 Surgery is associated with a high rate of morbidity and mortality. 1,6,7 Endovascular techniques may be a better treatment option, as they carry a lower risk of morbidity; however, data supporting the use of these techniques are currently lacking.…”

The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis

“…These 23 studies consisted of 17 prospective studies and six retrospective studies . In terms of history and physical examination findings, 19 studies were able to contribute prevalence data and estimates of test sensitivity . A summary of all studies contributing data can be reviewed in Data Supplement S1 (available as supporting information in the online version of this paper).…”

“…Given that the surgical outcomes literature is composed predominantly of retrospective studies, it is critically important to understand how cases were selected to judge bias and applicability. Studies reporting surgical outcomes may specify patients by procedure (bowel resection, revascularization), type of vascular occlusion (mesenteric venous thrombosis, superior mesenteric artery), or final diagnosis (ICD‐9 codes, autopsy reports). Studies reporting diagnostic modalities (laboratory or imaging) may report on patient outcomes stratified by surgical intervention and diagnosis, but this is unfortunately not universal.…”

“…Acute mesenteric ischemia is a rare disease, with an annual incidence of 0.09% to 0.2% per patient year, although the disease is thought to be underreported . Accordingly, acute mesenteric ischemia is an infrequent cause of abdominal pain in emergency department (ED) patients; however, mortality for this condition is high . Rapid diagnosis and surgical intervention are paramount to limiting mortality, but presenting signs are often vague or variable, and there is no pathognomonic laboratory screening test .…”