Vascular Health and Risk Management (Nov 2020)
Clinical Features and Factors Affecting Postoperative Mortality for Obstructive Acute Mesenteric Ischemia in China: A Hospital- Based Survey
Abstract
Wenhan Wu, Lie Yang, Zongguang Zhou Institute of Digestive Surgery of Sichuan University and Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of ChinaCorrespondence: Zongguang ZhouInstitute of Digestive Surgery of Sichuan University and Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of ChinaTel 86-18980601007Email [email protected]: The study aimed to report the clinical manifestation and identify the risk factors for postoperative mortality in patients who were diagnosed with obstructive acute mesenteric ischemia (AMI) based on a survey of a hospital in western China.Patients and Methods: We reviewed clinical data of 108 patients with obstructive AMI at West China Hospital, Sichuan University, from 2011 to 2017. Clinical characteristic was described and compared. Factors affecting postoperative survival were analyzed.Results: A total of 108 obstructive AMI cases were included in this study, with an overall average age of 57.1 years, including 58 arterial occlusive mesenteric ischemia (AOMI) and 50 mesenteric venous thrombosis (MVT). AOMI patients were older and had a significantly higher frequency of these comorbidities, including heart disease, hypertension, and diabetes. In comparison, MVT had a significantly higher proportion of male patients and a higher frequency of liver disease. A total of 77 patients underwent laparotomy, and the 30-day postoperative mortality rate was 29.9%. Multivariate logistic regression analysis showed that the time interval from admission to surgery (adjust OR 1.19; 95% CI [1.07– 1.34], P = 0.005), platelet count (adjust OR = 0.98; 95% CI [0.97– 0.99], P = 0.008) and AOMI (adjust OR = 5.55; 95% CI [1.36– 22.55], P = 0.017) were independent predictors of 30-day mortality after exploratory laparotomy for obstructive AMI. Further analysis of the 45 AOMI showed that the time interval from admission to surgery (adjustOR 1.22; 95% CI [1.01– 1.47], P = 0.036) and platelet count (adjustOR = 0.98; 95% CI [0.97– 0.99], P = 0.020) were independent risk factors for 30-day postoperative mortality of AOMI.Conclusion: Early identification of AOMI, improving the efficiency of enhanced CT examination, strengthening doctor–patient communication, active laparotomy, and optimize platelet management may also help reduce the overall short-term mortality of obstructive AMI. Building the multidisciplinary team model of diagnostic imaging, vascular intervention, and surgical treatment to manage obstructive AMI may be urgently needed in western China.Keywords: obstructive acute mesenteric ischemia, risk factors, laparotomy, outcome
