J. M. Shellenberger1, J. Clavenger1, L. Hanley1, S. Barnes1, S. Ahmad1 1University Of Missouri,Columbia, MO, USA
Introduction:
Acute mesenteric ischemia is a surgical emergency with a historical 30% thirty-day mortality. We analyzed the largest set of ACS NSQIP data in the literature to identify clinical variables that affect mortality for acute mesenteric ischemia.
Methods:
The ACS NSQIP database was queried from 2005 to 2013 for emergent operations for acute mesenteric ischemia. Inclusion criteria narrowed those cases to enterectomies, colectomies or combined as the initial operation. Univariate correlations were examined between mortality and pre-operative comorbidities, post-operative complications, and operations performed. A multivariate logistic regression model, controlled for age, gender and race was developed to evaluate the most significant univariate correlations.
Results:
5237 cases met the inclusion criteria and constituted the analysis group. Overall mortality rate was 28.7%. There were 1978 cases of isolated enterectomies, 2949 cases of isolated colectomies and 310 cases of combined resections. Mortality rates were 24.2%, 29.4% and 50.6% respectively. The increased risk of death with a combined small and large bowel resection was 2.74 (OR 95% CI 2.17-3.45). Pre-operative variables that most significantly increased the risk of death were ventilator dependence (OR 4.1, 95% CI 4.1-5.5), sepsis (OR 3.37, 95% CI 2.84-3.98), renal failure (OR 2.95, 95% CI 2.16-3.1), blood transfusion (OR 2.39, 95% CI 1.9 – 3.0) and time to OR from hospital admission greater than one day (OR 1.9, 95% CI 1.7-2.2). Post-operative outcomes that most significantly increased the risk of death were cardiac arrest (OR 10.2, 95% CI 6.69-15.48), septic shock (OR 2.4, 95% CI – 1.64-3.51), intra-operative blood transfusion (OR 2.1, 95% CI 1.7-2.5), renal failure (OR 1.87, 95% CI – 1.4-2.6), and post-operative blood transfusion (OR 1.5, 95% CI 1.2-1.9). In our multivariate logistical regression model pre-operative ventilator dependence (OR 3.6, 95% CI 2.9-4.5), sepsis (OR 1.9, 95% CI 1.5-2.4), post-operative septic shock (OR 2.9, 95% CI 2.3-3.7) and cardiac arrest (OR 11.13, 95% CI 7.2-17.2) were most predictive of mortality.
Conclusion:
Our analysis is the first suggestion of an increased risk of death with a combined small intestinal and colonic resection for acute mesenteric ischemia in the literature. This may reflect the extent, severity and progression of disease on initial presentation. Comorbidities, complications and timing of surgical intervention all contribute significantly to outcomes in the emergent surgical management of acute mesenteric ischemia.