Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia
Open accessAbstract
Objective Acute mesenteric ischemia (AMI) continues to be one of the most devastating diagnoses requiring emergent vascular intervention. There is a national trend toward increased use of endovascular procedures, with improved survival for the treatment of these patients. Our aim was to evaluate whether this trend has changed the treatment of AMI and the subsequent impact on length of hospitalization and hospitalization costs.Methods We identified all patients admitted for AMI from the National Inpatient Sample from 2004 to 2014 who received open surgical revascularization (OPEN) or an endovascular intervention (ENDO). Primary end points included length of hospital stay and cost of hospitalization. Our secondary end points included acute kidney injury (AKI), in-hospital mortality, and routine discharge.Results Among 10,381 discharges identified in the data set, 3833 (37%; 97.5% confidence interval [CI], 35%-39%) were male patients with a mean age of 69 years (range, 18-98 years); 4543 (44%; 97.5% CI, 41%-47%) patients were treated ENDO, and 5839 (56%; 97.5% CI, 53%-59%) patients were treated OPEN. Although a higher proportion of patients in the ENDO group (28%; 97.5% CI, 24%-31%) vs the OPEN group (14%; 97.5% CI, 11%-16%) had a moderate to severe Charlson Comorbidity Index (P < .0001), ENDO was associated with a lower mortality rate (12.3% [97.5% CI, 9.8%-14.8%] vs 33.1% [97.5% CI, 29.9%-36.2%]; P < .0001) and a lower mean hospitalization cost ($41,615 [97.5% CI, $38,663-$44,567] vs $60,286 [97.5% CI, $56,736-$63,836]; P < .0001). After propensity-adjusted logistic regression analysis, OPEN retained a significant association with higher mortality than ENDO (odds ratio, 3.0; 97.5% CI, 2.2-4.1) and with higher costs (mean, $9196; 97.5% CI, $3797-$14,595). Patients in the OPEN group had higher risk for AKI (P < .0001) and discharge to a skilled nursing facility (P < .0001) rather than home.Conclusions Although the rate of ENDO continues to rise nationally, it still has not surpassed OPEN revascularization in the face of AMI. Patients treated endovascularly demonstrated one-third the rate of in-hospital mortality (odds ratio, 3.0; 97.5% CI, 2.2-4.1), an increased hazard ratio for discharge alive (hazard ratio, 2.27; 97.5% CI, 2.00-2.58), and a cost saving of $9196 (97.5% CI, $3797-$14,595) per hospitalization. Furthermore, they were less likely to develop AKI and to be discharged home after hospitalization.
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Larger database analyses consistently show endovascular interventions are associated with improved postoperative morbidity and mortality, lower in-hospital mortality, lower bowel resection, decreased need for parenteral nutrition, shorter hospital stays, and lower cost compared to open surgery.
“larger database analyses have consistently shown that these interventions are associated with improved postoperative morbidity and mortality, lower rates of in-hospital mortality, lower rates of bowel resection, decreased need for parenteral nutrition, shorter hospital stays, and lower cost compared to open surgery [53,74,75,76].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [75]
The Results (p. 5) report lower in-hospital mortality, bowel-resection rates, acute kidney injury, and hospitalization costs with endovascular treatment; the Discussion (p. 7) reports a shorter hospital stay. The paper does not report a decreased need for parenteral nutrition, and its postoperative-complication finding is specific to acute kidney injury rather than morbidity overall. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEndovascular treatment was associated with cost savings, whereas patients in the open group had a higher risk of acute kidney injury and were often discharged to a nursing facility rather than home.
“In addition, endovascular treatment was associated with cost savings, whereas patients in the open group had a higher risk of acute kidney injury and were often discharged to a nursing facility rather than home. 161”
A nationwide analysis based on the US National Inpatient Sample showed a lower mortality rate for patients with AMI treated endovascularly compared with open revascularisation even though patients in the endovascular group had a higher comorbidity index.
“A nationwide analysis based on the US National Inpatient Sample showed a lower mortality rate for patients with AMI treated endovascularly compared with open revascularisation even though patients in the endovascular group had a higher comorbidity index.”
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Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review
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- Authors
- Erben, Y., Protack, C. D., Jean, R. A., Sumpio, B. J., Miller, S. M., Liu, S., Trejo, G., & Sumpio, B. E.
- Affiliations
- Yale University (US)
- Brown University (US)
- Corresponding author
- Erben, Young
- ORCID
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 68
- Issue
- 2
- Pages
- 459-469
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2786317554
- Cited by
- 40
- References
- 40
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 5 · 2019: 5
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (TL1TR001864)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- acute mesenteric ischemia, endovascular revascularization, open surgical revascularization, length of hospital stay, hospital costs, cost-effectiveness, in-hospital mortality, acute kidney injury, Charlson Comorbidity Index, National Inpatient Sample, propensity score matching, endovascular stent graft, mesenteric artery occlusion
- MeSH terms
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Length of Stay, Male, Mesenteric Vascular Occlusion, Middle Aged, Patient Discharge, Retrospective Studies, Risk Factors, Splanchnic Circulation, Time Factors, United States, Vascular Surgical Procedures, Comorbidity, Multivariate Analysis, Linear Models, Logistic Models, Proportional Hazards Models, Odds Ratio, Databases, Factual, Treatment Outcome, Cost Savings, Hospital Mortality, Hospital Costs, Young Adult, Propensity Score, Endovascular Procedures, Acute Kidney Injury, Mesenteric Ischemia
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