Perioperative mortality risk factors in acute mesenteric ischemia

Age, time delay to surgery, acidosis, cardiac illness and acute renal failure increase mortality in acute mesenteric ischemia, shows this month's issue of the World Journal of Surgery.

Acute intestinal ischemia is in most cases a lethal condition with a low survival rate.

Risk factors of perioperative mortality are poorly defined.

Dr Maria Asuncion Acosta-Merida and colleagues from Spain defined risk factors that predict an adverse outcome of acute mesenteric ischemia.

The research team evaluated a total of 132 consecutive patients with a mean age of 72 years.

The team underwent surgery because of acute mesenteric ischemia in a university tertiary care center 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.

The researchers found that 65% of patients died during the perioperative period as a direct result of acute mesenteric ischemia.

Significant univariate predictors of perioperative mortality were age, cardiopathy, digoxin intake, and shock.

Intestinal resection has a protective effect

World Journal of Surgery

The team observed that urea plasma level, creatinine, potassium, low pH, bicarbonate, hemoglobin of 2.5 mmol/L were significant predictors.

Time delay to surgery, colonic involvement, small and large bowel involvement were also predictors of mortality.

In addition, the team identified arterial versus venous ischemia, and intestinal resection as risk factors for mortality.

In the multivariate analysis, previous cardiac illness, and urea plasma levels, were independent risk factors of perioperative mortality.

The researchers noted that small and large bowel involvement were independent risk factors of perioperative mortality.

Intestinal resection was a favorable predictor.

Dr Asuncion Acosta-Merida's team concluded, “Age, time delay to surgery, shock, and acidosis significantly increase the risk of mortality due to acute mesenteric ischemia.”

“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 acute mesenteric ischemia.”