A Statewide Analysis of the Incidence and Outcomes of Mesenteric Ischemia in Maryland, 2009-2013

Abstract

Mesenteric ischemia is a surgical emergency that entails complex, multimodal management. Although associated with significant morbidity and mortality, the epidemiology and outcomes of this condition remain poorly defined. The aim of this study was to perform a population analysis of the contemporary incidence and outcomes of mesenteric ischemia. This was a retrospective analysis of mesenteric ischemia in the state of Maryland during 2009 to 2013 using a comprehensive statewide hospital admission database. Mesenteric ischemia was defined as an International Classification of Diseases, Ninth Revision code for intestinal ischemia plus the need for intra-abdominal surgery. Demographics, illness severity, comorbidities, and outcomes were studied. The primary outcome was inpatient mortality, and secondary outcomes were complications and inpatient lengths of stay. Survivors and nonsurvivors were analyzed by univariate analyses, with multivariable logistic regression analysis of risk factors for mortality. During the 5-year study period, there were 2,496,992 nontrauma hospital discharges in Maryland. Of these, 2402 patients (0.10%) had mesenteric ischemia and were primarily elderly and critically ill (Table). Inpatient mortality was high (24%), and on univariate analysis was associated with increasing age, colonic resection, and cardiovascular and renal comorbidities. Patients who died required more dialysis, mechanical ventilation, and transfusions than survivors. With multivariate analysis, independent risk factors (odds ratio [95% confidence interval]) for death were age >65 years (1.5 [1.2-1.9]), ischemic heart disease (1.5 [1.2-2.0]), renal insufficiency (1.8 [1.4-2.2]), dysrhythmia (1.4 [1.1-1.8]), hypercoagulability (2.6 [1.9-3.7]), and mechanical ventilation (3.2 [2.5-4.1]). Mesenteric ischemia occurs in ∼1/1000 admissions in Maryland. Patients with mesenteric ischemia have significant illness severity, substantial rates of organ dysfunction, and high mortality. Patients with chronic comorbidities and acute organ dysfunction are at increased risk of death, and recognition of these risk factors may enable prevention or earlier control of mesenteric ischemia in high-risk patients.TableMesenteric ischemia in MarylandVariablesAll patients (N = 2402)SurvivorsNonsurvivorsP valuen = 1825 (76%)n = 577 (24%)Age, ± SD years68 ± 1765 ± 1770 ± 15.0001Extreme APR severity of illness, No. (%)1603 (67)1045 (57)558 (97).0001Small bowel resection, No. (%)989 (41)842 (46)147 (25).01Colon resection, No. (%)1228 (51)907 (50)321 (56).0001Chronic ischemic heart disease, No. (%)431 (18)297 (16)134 (23).0001Chronic kidney disease, No. (%)910 (38)552 (30)358 (62).0001Mechanical ventilation, No. (%)938 (39)517 (28)421 (17).0001Inpatient dialysis, No. (%)194 (8)98 (5)96 (17).0001Hospital length of stay, days (IQR)11 (6-20)11 (7-20)8 (3-18).0001APR, All Patient Refined; IQR, interquartile range; SD, standard deviation. Open table in a new tab