title: A Statewide Analysis of the Incidence and Outcomes of Acute Mesenteric Ischemia in Maryland from 2009 to 2013.
abstract: BACKGROUND
  Acute mesenteric ischemia is a surgical emergency that entails complex, multi-modal management, but its epidemiology and outcomes remain poorly defined. The aim of this study was to perform a population analysis of the contemporary incidence and outcomes of mesenteric ischemia.
  
  
  METHODS
  This was a retrospective analysis of acute mesenteric ischemia in the state of Maryland during 2009-2013 using a comprehensive statewide hospital admission database. Demographics, illness severity, comorbidities, and outcomes were studied. The primary outcome was inpatient mortality. Survivors and non-survivors were compared using univariate analyses, and multivariable logistic regression analysis was performed to evaluate risk factors for mortality.
  
  
  RESULTS
  During the 5-year study period, there were 3,157,499 adult hospital admissions in Maryland. A total of 2,255 patients (0.07%) had acute mesenteric ischemia, yielding an annual admission rate of 10/100,000. Increasing age, hypercoagulability, cardiac dysrhythmia, renal insufficiency, increasing illness severity, and tertiary hospital admission were associated with development of mesenteric ischemia. Inpatient mortality was high (24%). After multivariate analysis, independent risk factors for death were age >65 years, critical illness severity, mechanical ventilation, tertiary hospital admission, hypercoagulability, renal insufficiency, and dysrhythmia.
  
  
  CONCLUSIONS
  Acute mesenteric ischemia occurs in approximately 1/1,000 admissions in Maryland. Patients with mesenteric ischemia have significant illness severity, substantial rates of organ dysfunction, and high mortality. Patients with chronic comorbidities and acute organ dysfunction are at increased risk of death, and recognition of these risk factors may enable prevention or earlier control of mesenteric ischemia in high-risk patients.
authors.affiliation: Division of Vascular Surgery, Center for Aortic Disease, Department of Surgery, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Crawford
authors.affiliation: Division of Vascular Surgery, Center for Aortic Disease, Department of Surgery, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Donald G
authors.initials: DG
authors.lastname: Harris
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Elena N
authors.initials: EN
authors.lastname: Klyushnenkova
authors.affiliation: Division of Acute Care Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Tesoriero
authors.affiliation: Division of Acute Care Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rabin
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Hegang
authors.initials: H
authors.lastname: Chen
authors.affiliation: Division of Acute Care Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine , Baltimore, MD , USA.
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Diaz
keywords: acute mesenteric ischemia; emergency surgery; epidemiology; surgical critical care