Affiliation:
1. University of Tsukuba Hospital
Abstract
Abstract
Purpose
The mortality rate of non-occlusive mesenteric ischemia remains despite surviving the acute postoperative period with tremendous treatment efforts, including emergency surgery, which is challenging. This study explored the preoperative risk factors for 90-day postoperative mortality in patients with non-occlusive mesenteric ischemia.
Methods
This was a single-center retrospective cohort study. Patients diagnosed with non-occlusive mesenteric ischemia who underwent emergency surgery between August 2014 and January 2023 were included in this study. All patients were divided into survival-to-discharge and mortality outcome groups at the 90-day postoperative follow-up. Preoperative factors, including co-morbidities, preoperative status of vital signs and consciousness, blood gas analysis, blood test results, and computed tomography, were compared between the two groups.
Results
Twenty patients were eligible for this study, and 90-day mortality was observed in 10 patients (50%). The mortality outcome group had significantly lower HCO3- (20.9 vs. 14.6, p = 0.006) and higher lactate (4.4 vs. 9.4, p = 0.023) compared with the survival outcome group. The median postoperative time to death was 19 [2–69] days, and five patients (50%) died after postoperative day 30, mainly because hemodialysis was discontinued due to hemodynamic instability in patients requiring hemodialysis.
Conclusion
Low preoperative HCO3- and high lactate levels may be preoperative risk factors for 90-day postoperative mortality in patients with non-occlusive mesenteric ischemia. However, patients on hemodialysis die from discontinuing hemodialysis even after surviving the acute postoperative phase. Hence, indications for emergency surgery in patients with risk factors for postoperative mortality should be carefully determined.
Publisher
Research Square Platform LLC
Reference17 articles.
1. Infarction of the bowel in cardiac failure;Ende N;N Engl J Med,1958
2. Intestinal gangrene without apparent vascular occlusion;Heer FW;Am J Surg,2002
3. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy;Trompeter M;Eur Radiol,2002
4. Diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI);Stöckmann H;Zentralbl Chir,2000
5. Acute mesenteric ischemia;Mishima Y;Jpn J Surg,1988