Impact of etiologic factors and APACHE II and POSSUM scores in management and clinical outcome of acute intestinal ischemic disorders after surgical treatment.
BACKGROUND
Acute intestinal ischemic disorder (AIID) is an uncommon vascular disease with high mortality. According to etiology, it can be categorized into three groups: arterial occlusive mesenteric ischemia (AOMI), mesenteric venous thrombosis (MVT), and nonocclusive mesenteric ischemia (NOMI). This study analyzes the effect of classification on surgical outcome.


METHODS
All AIID patients who underwent operative treatment at National Cheng Kung University Hospital between January 1989 and August 2003 were enrolled in this study. Preoperative information on these patients was compared to find predictors of outcome.


RESULTS
Data from 77 patients (49 men and 28 women, median age 70 years) were analyzed. The etiology was AOMI in 30 patients, MVT in 19 patients, and NOMI in 28 patients. Median age was younger in MVT (54 years) than in AOMI (70 years) or NOMI (72 years). In addition, MVT usually involved the jejunum (74%, versus 31% in AOMI and 46% in NOMI), whereas both AOMI and NOMI involved ileum and colon. The patients with AOMI had shorter duration of symptoms and higher ratio of underlying hypertension than those with MVT. The overall mortality rate was 53.2% (41/77). The day 1 and day 30 mortality were 0% and 10.5% in MVT, 16.7% and 30% in AOMI, and 42.9% and 67.9% in NOMI, respectively (P < 0.05). Both the etiology and the APACHE II scores were significant risk factors for day 30 and long-term mortality. The patients with NOMI had higher POSSUM physiologic scores than patients with MVT. The P-POSSUM regression equation can accurately predict mortality.


CONCLUSIONS
Patients with MVT had a more favorable prognosis, whereas those with NOMI had the worst outlook. The APACHE II and POSSUM scoring systems are useful in predicting the clinical outcome. Early diagnosis and classification of AIID patients are useful for aggressive treatment to improve the clinical outcome.
Hsu
Hui-Ping
HP
Department of Surgery, National Cheng Kung University Hospital, No. 138, Sheng-Li Road, Tainan, 70428 Taiwan.
Shan
Yan-Shen
YS
Hsieh
Yu-Hsiang
YH
Sy
Edgar D
ED
Lin
Pin-Wen
PW
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003663:Decision Trees; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome