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Experience in the treatment of Mesenteric Ischemia from 2005 - 2010 in NSQIP hospitals
Jordan Knepper, MD1, Nicholas Osborne, MD1, John Rectenwald, III, MD1, Gilbert R. Upchurch, Jr., MD2.
1University of Michigan, Ann Arbor, MI, USA, 2University of Virginia, Charlottesville, VA, USA.
Objective: This goal of your study is the identity patient, operative and hospital characteristics that may contribute to outcome differences in patients undergoing surgical treatment of mesenteric ischemia. Previous data indicate experiences in single and multiple institutions and in other administrative databases, but this is the first description of mesenteric ischemia using a surgical database such as NSQIP.
Methods: Using multiple years of NSQIP data files from 2005 to 2010 a database was generated for all patients with ICD 9 codes representing mesenteric ischemia. These were sub-grouped by specific procedure performed using CPT codes. These data were analyzed using bivariate and multivariate analyses in STATA 12.1.
Results: There were 5758 patients identified with mesenteric ischemia. Of these, 556 had a revascularization procedure. The table below describes patient characteristics. Of those that died, multivariate analyses show age, pre-operative weight-loss, ASA class 4 or 5 and emergent cases were significantly associated with increased mortality (P<0.001). While bowel resection and mesenteric revascularization were significant and associated with survival (P<0.05).
Conclusion: NSQIP data provides descriptive evaluation of a large contemporary series of patients with mesenteric ischemia and suggests that the majority of cases of acute mesenteric ischemia are treated with bowel resection alone. Patients treated with revascularization procedures tended to have better outcomes. Mesenteric ischemia continues to represent a high mortality diagnosis.
Patients with Mesenteric Ischemia - Pre and post operative factors | Mesenteric Revascularization | No Revascularization | Total | | Number | 556 | 5202 | 5758 | | Age | 67- average | 67 - average | - | | Died (30 day) | 111 (20%) | 1543 (29.7%) | 1654 (28.7%) | | Colon Resection | 44 (7.9%) | 2415 (46.4%) | 2459 (42.7%) | | Small Bowel Resection | 77 (13.8%) | 1661 (31.9%) | 1734 (30.1%) | | Pre-operative weight-loss | 148 (26.6%) | 385 (7.3%) | 533 (9.3%) | | Re-operation | 201 (36.1%) | 1269 (24.4%) | 1407 (24.4%) | | ASA class 4 or 5 | 243 (43.7%) | 2858 (54.9%) | 3101 (53.8%) | | Urgent/ Emergent Case | 241 (43%) | 3769 (72.5%) | 4010 (69.6%) |
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