Identification of risk factors for perioperative mortality in acute mesenteric ischemia.
BACKGROUND
Acute intestinal ischemia is in most cases a lethal condition with a low survival rate. Risk factors of perioperative mortality are poorly defined. The aim of this study was to define risk factors that predict an adverse outcome of acute mesenteric ischemia (AMI).


METHODS
A total of 132 consecutive patients (73 men, 59 women), mean+/-SD age 71.96+/-13.64 years, who underwent surgery because of AMI in a university tertiary care center were evaluated over a period of 10 years. Clinical features, laboratory findings, etiologic factors, and surgical procedures were recorded and assessed as possible risk factors for perioperative mortality.


RESULTS
Of 132 patients, 86 (65.2%) died during the perioperative period as a direct result of AMI. Significant univariate predictors of perioperative mortality were age (P=0.01), cardiopathy (P=0.002), digoxin intake (P=0.015), shock (P=0.01), urea plasma level (P<0.001), creatinine (P<0.001), potassium (P=0.042), low pH (P=0.015) and bicarbonate (P=0.035); hemoglobin>or=2.48 mmol/L (P=0.035); time delay to surgery (P=0.023); colonic involvement (P<0.001); small and large bowel involvement (P<0.001); arterial versus venous ischemia (P=0.007); and intestinal resection (P<0.001). In the multivariate analysis, the variables previous cardiac illness (P=0.045), urea plasma levels (P<0.001), and small and large bowel involvement were identified as independent risk factors of perioperative mortality. Intestinal resection (P<0.001) was a favorable predictor.


CONCLUSIONS
Age, time delay to surgery, shock, and acidosis significantly increase the risk of mortality due to AMI, whereas intestinal resection has a protective effect. However, only previous cardiac illness, acute renal failure, and large bowel ischemia have a negative effect as independent risk factors of mortality of AMI.
Acosta-Merida
Maria Asuncion
MA
Department of Surgery, University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Marchena-Gomez
Joaquin
J
Hemmersbach-Miller
Marion
M
Roque-Castellano
Cristina
C
Hernandez-Romero
Juan Maria
JM
D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D004617:Embolism; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply* / Q000601:surgery; D007511:Ischemia / Q000401:mortality*; D008297:Male; D008638:Mesenteric Arteries; D017538:Mesenteric Artery, Superior; D008641:Mesenteric Vascular Occlusion / Q000401:mortality* / Q000601:surgery; D008642:Mesenteric Veins; D008875:Middle Aged; D012307:Risk Factors; D013927:Thrombosis; D014656:Vascular Surgical Procedures