Allain Charlotte, Besch Guillaume, Guelle Nicolas, Rinckenbach Simon, Salomon du Mont Lucie
Department of vascular surgery, Besançon University Hospital, Besançon, France.
EA3920, Besançon University Hospital, Besançon, France; Department of anesthesiology, Besançon University Hospital, Besançon France.
Ann Vasc Surg. 2019 Jul;58:24-31. doi: 10.1016/j.avsg.2019.02.009. Epub 2019 Apr 19.
Patients suffering from chronic mesenteric ischemia are at risk of malnutrition due to the fear of food and weight loss. However, the impact of malnutrition on the morbidity and mortality at the time of surgery is not studied extensively, just as its prevalence. The main objective of this study was to evaluate the influence of malnutrition on the survival of the patients operated for chronic mesenteric ischemia. The secondary objectives were to evaluate the prevalence of malnutrition in this population and to evaluate the early complications after surgery according to the nutritional condition of the patients.
We conducted a monocentric retrospective observational study including consecutively all the patients operated for chronic mesenteric ischemia between 2005 and 2016. The nutritional status was determined a posteriori according to the criteria of the French High Health Authority using body mass index, the percentage of weight loss, and albumin. We thus divided the patients into 2 groups, "malnourished" and "non-malnourished." We compared the survival of the patients of the 2 groups with a log-rank test.
We enrolled 54 patients including 35 men (65%), with a mean age of 68.1 years (±12.3). The prevalence of malnutrition was 70% (38 patients), including 9 severely malnourished patients (23.6%). Twenty-nine patients (53.7%) were treated by endovascular technique, and twenty-five had conventional surgery (46.3%). The type of management was not different between the 2 groups: 20 patients of the malnourished group (52.6%) and 9 patients of the non-malnourished group (56.3%) were treated by endovascular technique (P = 0.8). The 30-day mortality was null in the non-malnourished group, whereas ten patients (26.3%) died in the malnourished group (P = 0.02). The short-term complications were not significantly different between the malnourished and the non-malnourished groups (37% vs. 19%, P = 0.32). The mean duration of follow-up was 639 days (±660). The 3-year survival was not different between the endovascular group and the open surgery group (43% vs. 52%, P = 0.7). The 3-year survival was statistically higher in the non-malnourished group (87%) than in the malnourished group (49.6%) (P = 0.01).
In our experience, preoperative malnutrition is a factor significantly decreasing the survival of the patients treated with open surgery or with endovascular technique for chronic mesenteric ischemia. A more optimal preoperative management of this malnutrition could improve the results of these procedures.
由于对食物的恐惧和体重减轻，慢性肠系膜缺血患者存在营养不良风险。然而，营养不良对手术时发病率和死亡率的影响以及其患病率尚未得到广泛研究。本研究的主要目的是评估营养不良对接受慢性肠系膜缺血手术患者生存的影响。次要目的是评估该人群中营养不良的患病率，并根据患者的营养状况评估术后早期并发症。
我们进行了一项单中心回顾性观察研究，连续纳入2005年至2016年间所有接受慢性肠系膜缺血手术的患者。根据法国高级卫生管理局的标准，使用体重指数、体重减轻百分比和白蛋白对营养状况进行事后确定。因此，我们将患者分为两组，“营养不良组”和“非营养不良组”。我们使用对数秩检验比较两组患者的生存率。
我们纳入了54例患者，其中男性35例（65%），平均年龄68.1岁（±12.3）。营养不良的患病率为70%（38例患者），其中9例为严重营养不良患者（23.6%）。29例患者（53.7%）接受了血管内技术治疗，25例接受了传统手术（46.3%）。两组的治疗方式无差异：营养不良组20例患者（52.6%）和非营养不良组9例患者（56.3%）接受了血管内技术治疗（P = 0.8）。非营养不良组30天死亡率为零，而营养不良组有10例患者（26.3%）死亡（P = 0.02）。营养不良组和非营养不良组的短期并发症无显著差异（37%对19%，P = 0.32）。平均随访时间为639天（±660）。血管内组和开放手术组的3年生存率无差异（43%对52%，P = 0.7）。非营养不良组的3年生存率（87%）在统计学上高于营养不良组（49.6%）（P = 0.01）。
根据我们的经验，术前营养不良是显著降低接受开放手术或血管内技术治疗慢性肠系膜缺血患者生存率的一个因素。对这种营养不良进行更优化的术前管理可能会改善这些手术的结果。
