Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

Y. Erben; A. C. Spaulding; G. S. Oderich; J. A. Da Rocha-Franco; H. Farres; J. J. Cochuyt; W. S. Sorrells; A. W. Oldenburg; G. T. Frey; B. B. Toskich; R. Becher; A. G. Hakaim

doi:10.1055/s-0039-1700984

International Journal of Angiology, Table of Contents

Int J Angiol 2020; 29(03): 189-195
DOI: 10.1055/s-0039-1700984

Original Article

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

Y. Erben

¹Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida

,

A. C. Spaulding

²Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida

,

G. S. Oderich

³Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota

,

J. A. Da Rocha-Franco

¹Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida

,

H. Farres

¹Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida

,

J. J. Cochuyt

²Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida

,

W. S. Sorrells

¹Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida

,

A. W. Oldenburg

¹Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida

,

G. T. Frey

⁴Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, Florida

,

B. B. Toskich

⁴Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, Florida

,

R. Becher

⁵Section of General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut

,

A. G. Hakaim

¹Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida

› Author Affiliations

Abstract

Acute mesenteric ischemia (AMI) remains a vascular emergency. Our aim was to explore readmission for AMI. We identified all patients admitted for AMI from the state of California through the Healthcare and Utilization Project from 2005 to 2011. Our primary end point was the rate and etiology for readmission. Our secondary end points were the length of hospitalization and in-hospital mortality. Cox proportional hazard regression was utilized to assess risk of 30-day readmission. There were 534 (9.9%) readmissions at 30 days. The mean age was 67 ± 17 years and 209 (39.1%) were male. The five most common etiologies for readmission were AMI (7.6%), cardiac events (5.3%), severe sepsis (1.2%), dehydration (1.1%), and acute kidney failure (1.1%). Once readmitted, these patients were most likely to experience cardiac catheterizations (25.4%), red blood cell transfusions (23.6%), intubation and mechanical ventilation (17.6%), biopsy of the large intestine (13.9%), reoperation for small bowel resection (10.9%), administration of total parenteral nutrition (10.5%), and transfusion of other blood products (6.9%). This hospitalization was 8.8 ± 12.7 days long. In-hospital mortality was 36 patients (6.7%). On multivariable Cox-regression analysis, severe (hazard ratio [HR]: 2.1 [1.4–3.2], p = 0.0005) and moderate (HR: 1.5 [1.03–2.13], p = 0.04) Elixhauser Comorbidity Group, complications (HR: 1.5 [1.2–1.9], p = 0.0007), and longer index hospitalization (HR: 1.02 [1.01–1.02], p < 0.0001) were predictors of readmission. Conclusion AMI remains a vascular emergency. Readmissions have a significant rate of morbid invasive procedures and can lead to an in-hospital mortality of 6.7%. The adoption of guidelines similar to the European Society for Trauma and Emergency Surgery should be considered.

Keywords

mesenteric ischemia - acute mesenteric ischemia - readmission - guidelines - mortality - treatment - length of hospitalization

Full Text

References

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Supplementary Material

Supplementary Material