title: Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques.
abstract: BACKGROUND
  In this study, we evaluated if increase in utilization of endovascular surgery has affected in-hospital mortality rates among patients with acute mesenteric ischemia.
  
  
  METHODS
  The National Inpatient Sample (2003-2011) was queried for acute mesenteric ischemia using ICD-9 code for acute mesenteric ischemia (557.1). This cohort was divided into patients treated with open vascular surgery (open vascular group) and by endovascular therapies (endovascular group) based on the ICD-9CM procedure codes. Multivariable logistic regression was used to determine temporal trend for mortality while adjusting for confounding variables.
  
  
  RESULTS
  There was 1.45-fold increase in utilization of endovascular techniques in this study. In-hospital mortality rate, total median charges and length of stay were significantly lower among the endovascular group than the open vascular group despite having significantly higher Elixhauser comorbidities index (3 ± 0.1 vs. 2.7 ± 0.1, p = .003). Over the course of the study period, there was no change in the overall mortality rate despite higher endovascular utilization. Factors associated with increased mortality included age, open surgical repair (Odds ratio: 1.45, 95% Confidence Interval: 1.10-1.91, p = .016) and bowel resection Odds ratio: 2.88, 95% Confidence Interval: 2.01-4.12).
  
  
  CONCLUSIONS
  The mortality rate for acute mesenteric ischemia remains unchanged throughout this contemporary study. Open surgical intervention, bowel resection and age were associated with increased mortality. Endovascular group patients had better survival despite higher morbidity indices.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA, USA Mohammad.eslami@bmc.org.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Department of Biostatistics, Boston School of Public Health, Boston, MA, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston School of Public Health, Boston, MA, USA.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular Surgery, Boston VA Medical Center, West Roxbury, MA, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: McPhee
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality* / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D017721:Hospital Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D016015:Logistic Models; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality* / Q000706:statistics & numerical data / Q000639:trends*; D055815:Young Adult
keywords: Acute mesenteric ischemia; endovascular utilization; mortality rates; resources utilization