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Chronic Mesenteric Ischemia: A Comparison of In-Hospital Post-Operative Complications of Endovascular and Open Revascularization
Abstract:
Background: The aim of this study was to compare the in-hospital post-operative complications and post-operative mortality in patients who were diagnosed with Chronic Mesenteric Ischemia (CMI) and treated by either endovascular revascularization (ER) or by open revascularization (OR) between 2008 and 2010 from the National Inpatient Sample (NIS) database.
Methods: Data of patients were collected using the (NIS) of the Healthcare Cost and Utilization Project (HCUP) using the ICD-9 coding system for the diagnosis, clinical features, complications, and treatment modalities. Data analysis was done using IBM SPSS Statistics version 19. A p value of <0.05 was considered to be statistically significant, which was calculated using Chi Square for categorical variables and using t-test for continuous variables.
Results: In a 3-year period, a total of 5772 patients (4040/70% were females) were treated for CMI. The mean age was 69.7±12.14 years, 4048/70.1% were treated by (ER). In the years 2008, 2009, and 2010, (ER) was done in (64.5%, 68.6%, and 75.1%, respectively), with a significant increase in 2010 compared to 2008 and 2009 (p <0.05). Caucasian patients underwent a significantly higher percentage of (ER) over (OR) compared to other races (White: 89.2% vs. others: 82.6%, p<0.05). Medicare patients constituted the largest proportion of (CMI) patients (4079/70.7%). The table below compares between ER and OR groups with respect to morbidities, mortality, length of stay (LOS), total charges (TC), and Medicare-insured patients.

		ER	OR
Morbidity and mortality	Cardiac Complications	1.3%	4.4%
	Pulmonary Complications	2.9%	17.7%
	Bowel Resection	1.1%	4.6%
	Mortality	4.3%	7.9%
Mean age		71.1 years	65.0 years
Length of stay		7.9 days	14.6 days
Total charges		$87,883.00	$143,696.00
Medicare-insured patients		3171/87.3%	907/53%

All the results are statistically significant at p<0.05
Conclusion: Revascularization by (ER) is becoming more implicated recently in the treatment of (CMI). Patients in (ER) group were significantly older than those in (OR) group. (ER) in (CMI) patients showed shorter (LOS), less (TC), less complication rates, as well as less mortality rate compared to OR group.