Despite Advances and Incorporation of Endovascular Techniques, Mortality Rates for Patients with Acute Mesenteric Ischemia Remain Unchanged: Analysis of the Nationwide Inpatient Sample

Abstract

Objectives: Adoption and advances in endovascular surgery have improved outcomes of vascular emergencies. We evaluated whether similar trends apply to the treatment of acute mesenteric ischemia (AMI) using a large inpatient database. Methods: The Nationwide Inpatient Sample (2003-2010) was queried using International Classification of Diseases, Ninth Revision code for AMI (557.1). Patients who had any open vascular or endovascular procedures were selected. This cohort was divided into the open vascular group (OVG) and endovascular group (EVG) based on the International Classification of Diseases, Ninth Revision procedure codes for primary and secondary procedures. Bivariate analyses were performed using c test, t-test, and gamma regression when appropriate. Logistic regression was used to determine factors affecting mortality while adjusting for confounding variables. Results: We identified 6683 patients of which majority had an endovascular procedure (4187, 62.7% vs 2496, 37.3%; P < .001) with an overall in-hospital mortality rate (IHM) of 17.4%. Age, race, and sex were similar across groups EVG had a significantly higher Elixhauser comorbidities index (3 6 1.6 vs 2.76 1.5; P 1⁄4 .007) and a significantly higher rate of peripheral vascular disease than OVG (44.5% vs 29.2%; P < .001). Despite this, EVG had significantly lower in-hospital mortality (IHM) rates (15.3% vs 21.2%, P 1⁄4 .006), median charges ($72,907 vs $101,762; P < .001), and length of stay (9 vs 14 days; P < .001) (Fig). Over the 8-year period of study, there was no change in the overall mortality rate among EVG or OVG groups. Factors affecting mortality rate included age (OR, 1.03; 95% CI, 1.02-1.04; P < .001) and open surgery (OR, 1.45; CI, 1.07-1.96; P 1⁄4 .016). Presence of peripheral vascular disease correlated with decreased overall mortality (OR, 0.60; CI, 0.43-0.85; P 1⁄4 .004). Conclusions: Despite incorporation of more advanced endovascular therapies, the mortality rate for AMI remains unchanged throughout the study period. Type of surgery and age are the most significant factors affecting mortality with EVG patients having better survival despite higher morbidity indices.