Surgery for mesenteric infarction: Prognostic factors associated with early death within 72 hours

Abstract

Objective The aim of this study was to look for preoperative and postoperative prognostic factors for early mortality, likely to be of use to clinicians in decision making.Design Prospective multicenter study.Setting This study was conducted in 4 university hospitals in Northeast France.Participants One hundred thirty-one patients with mesenteric infarction confirmed by pathologic examination were included.Interventions All patients underwent surgery and were hospitalized in the intensive care unit.Main results Twenty-eight patients (21.3%) underwent exploratory laparotomy only; 103 patients underwent bowel resection with/or without associated revascularization. The overall mortality rate at discharge was 74.8%. In the first 3 days, 60% of deaths occurred. The prognostic factors for death within 72 hours, obtained by logistic regression, were preoperative heart failure, lactate level over 5 mmol/L, aspartate aminotransferase over 200 IU/L, and total cholesterol level below 80 mg/dL, or procalcitonin level over 40 ng/L. From these results, a mortality prognostic score was derived. Probability of mortality within 72 hours was estimated to be 5% for patients with none of these factors and 97% for those with all 4. For deaths occurring after 72 hours, the only mortality prognostic factor was the existence of necrosed areas at the ends of bowel resections.Conclusion When patients have fewer than 3 of the prognostic factors described in the score, aggressive medical and surgical strategies could be appropriate. If necrosis is recorded at the ends of the resection, renewed surgery should be undertaken as soon as signs of new disturbances appear.