Abstract
Objective Our objective was to comprehensively present the evidence of preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy. Methods PubMed, Embase, and Google Scholar were searched from January 2000 to January 2020. Studies evaluating the postoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy were included. The outcome extracted were patients' demographics, medical history, and preoperative laboratory tests. Results Twenty studies (5011 patients) met the inclusion criteria. Studies were of high quality, with a median Newcastle-Ottawa Scale Score of 7. Summary short-term postoperative mortality was 44.38% (range, 18.80%–67.80%). Across included studies, 49 potential risk factors were examined, at least two studies. Meta-analysis of predictors based on more than three studies identified the following preoperative risk factors for higher short-term postoperative mortality risk: old age (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.57–2.30), arterial occlusive mesenteric ischemia versus mesenteric venous thrombosis (OR, 2.45, 95% CI 1.12–5.33), heart failure (OR 1.33, 95% CI 1.03–1.72), renal disorders (OR 1.61, 95% CI 1.24–2.07), and peripheral vascular disease (OR 1.38, 95% CI 1.00–1.91). Nonsurvivors were older (standardized mean difference [SMD], 0.32, 95% CI 0.24–0.40), had higher creatinine levels (SMD 0.50, 95% CI 0.25–0.75), and had lower platelet counts (SMD −0.32, 95% CI −0.50 to −0.14). Conclusion The short-term postoperative mortality of acute mesenteric ischemia who underwent laparotomy is still high. A better understanding of these risk factors may help in the early identification of high-risk patients, optimization of surgical procedure, and improvement of perioperative management.
Highlights
Acute mesenteric ischemia (AMI) is usually a collection for a group of diseases caused by sudden insufficiency of blood to the intestine, including arterial occlusive mesenteric ischemia (AOMI, 65%–75%), mesenteric venous thrombosis (MVT, 5%– 15%), and nonocclusive mesenteric ischemia (NOMI, 10%– 30%) [1]
The postoperative shortterm mortality rate is still about 40% [7, 8], which is undoubtedly disturbing. e preoperative risk factors related to the death of AMI after laparotomy remain unclear from the existing studies because of variations in design and Emergency Medicine International predictors investigated in these studies [9,10,11,12]
We present a summary and have used metaanalysis to quantify the preoperative risk factor for the shortterm mortality of AMI after laparotomy
Summary
Our objective was to comprehensively present the evidence of preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy. Studies evaluating the postoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy were included. Summary short-term postoperative mortality was 44.38% (range, 18.80%–67.80%). Meta-analysis of predictors based on more than three studies identified the following preoperative risk factors for higher short-term postoperative mortality risk: old age (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.57–2.30), arterial occlusive mesenteric ischemia versus mesenteric venous thrombosis (OR, 2.45, 95% CI 1.12–5.33), heart failure (OR 1.33, 95% CI 1.03–1.72), renal disorders (OR 1.61, 95% CI 1.24–2.07), and peripheral vascular disease (OR 1.38, 95% CI 1.00–1.91). E short-term postoperative mortality of acute mesenteric ischemia who underwent laparotomy is still high. A better understanding of these risk factors may help in the early identification of high-risk patients, optimization of surgical procedure, and improvement of perioperative management
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