Acute mesenteric ischemia: the importance of early surgical consultation
Abstract
Acute mesenteric ischemia continues to be associated with high mortality. We hypothesized that delays in surgical consultation and operation are independently associated with increased mortality and sought to identify modifiable characteristics associated with delayed management. We conducted a retrospective cohort study of 72 patients diagnosed with acute mesenteric ischemia. Twenty-six (36%) patients died, of which 14 (54%) had care withdrawn. Delay in operation (>6 hours after surgical consultation) was associated with increased mortality (adjusted OR 3.7; 90% CI, 1.1-12). For patients for whom care was not withdrawn, delay in surgical consultation (>24 hours after disease onset) was associated with increased mortality (adjusted OR, 9.4; 90% CI, 1.3-65), as was delay in operation (adjusted OR, 4.9; 90% CI, 1.1-22). For those managed medically, early surgical consultation was associated with improved mortality (Odds Ratio [OR], 0; 90% Confidence Interval [CI], 0-0.34). Patients with delayed surgical consultation were more likely to have abdominal distension, elevated lactate concentration, acute renal failure, vasopressor administration, and a lack of abdominal pain. The acquisition of CT imaging trended toward an association with delayed surgical consultation ( P = 0.06). We conclude that early surgical consultation is associated with improved outcome even for patients managed without operative intervention, and that CT imaging may delay appropriate care.
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Clinical signs of acute mesenteric ischaemia are non-specific and reliable specific biomarkers are lacking, so diagnosis is often delayed.
“As clinical signs of AMI are non-specific and reliable specific biomarkers are lacking, the diagnosis is often delayed resulting in progression of intestinal ischaemia to transmural intestinal necrosis and peritonitis before the diagnosis is made.”
From Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis (2022) · cites this paper as [84]
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- Authors
- Eltarawy, I. G., Etman, Y. M., Zenati, M., Simmons, R. L., & Rosengart, M. R.
- Affiliations
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Rosengart, Matthew R.
- Venue
- The American Surgeon™
- Publisher
- SAGE Publications
- Published
- 2009-03
- Volume
- 75
- Issue
- 3
- Pages
- 212-219
- ISSN
- 0003-1348 (ISSN-L)
- 1555-9823
- OpenAlex
- W2460959009
- Cited by
- 55
- References
- 25
- Citations by year
- 2024: 5 · 2023: 2 · 2022: 8 · 2021: 6 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 4 · 2015: 2 · 2014: 6 · 2013: 2 · 2012: 2
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Surgeon (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (KL2RR024154)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Rheumatology › Omental and Epiploic Conditions
- Keywords
- acute mesenteric ischemia, delayed surgery, mortality, computed tomography, medical management, abdominal distension, lactate, acute kidney injury, vasopressors, abdominal pain
- MeSH terms
- Acute Disease, Adult, Aged, Aged, 80 and over, Female, Humans, Ischemia, Male, Mesentery, Middle Aged, Pennsylvania, Radiography, Abdominal, Referral and Consultation, Retrospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Logistic Models, Treatment Outcome, Statistics, Nonparametric
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