Swerdlow Nicholas J, Varkevisser Rens R B, Soden Peter A, Zettervall Sara L, McCallum John C, Li Chun, Wyers Mark C, Schermerhorn Marc L
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ann Vasc Surg. 2019 Nov;61:148-155. doi: 10.1016/j.avsg.2019.05.024. Epub 2019 Aug 2.
Open revascularization for acute mesenteric ischemia (AMI) is associated with high perioperative morbidity and mortality; however, results from contemporary studies are varied. Therefore, we evaluated 30-day mortality after open revascularization for AMI and identified preoperative factors associated with mortality.
We performed a retrospective cohort study of patients in the American College of Surgeons National Surgical Quality Improvement Program database undergoing open mesenteric revascularization for AMI from 2005 to 2017. The primary outcome was 30-day mortality. We used multivariable logistic regression to identify preoperative factors independently associated with 30-day mortality.
The study cohort included 918 patients; their median age was 70 years (interquartile range: 59-80 years), 62% were female, and 90% were white. Thirty-day mortality after open revascularization for AMI was 32%, specifically 35% after embolectomy, 31% after thromboendarterectomy, and 28% after mesenteric bypass. Mortality was higher in patients requiring concomitant bowel resection (38% vs. 29%, respectively, P < 0.01). The preoperative factor most strongly associated with 30-day mortality was disseminated cancer (odds ratio = 8.8, 95% confidence interval = 2.4-32, P = 0.001). Other factors independently associated with mortality were renal dysfunction, preoperative intubation, preoperative blood transfusion, diabetes, elevated preoperative international normalized ratio, elevated preoperative white blood cell count, and increasing age.
In this retrospective cohort study using a real-world, nationwide cohort, open revascularization for AMI was associated with high mortality, with nearly one-third of patients dying within 30 days of their operation. The factors identified to be independently associated with 30-day mortality, particularly disseminated cancer, preoperative renal dysfunction, and elevated preoperative WBC count, are an important tool for preoperative risk stratification.
急性肠系膜缺血（AMI）的开放血管重建术与围手术期高发病率和死亡率相关；然而，当代研究的结果各不相同。因此，我们评估了AMI开放血管重建术后30天死亡率，并确定了与死亡率相关的术前因素。
我们对2005年至2017年在美国外科医师学会国家外科质量改进计划数据库中接受AMI开放肠系膜血管重建术的患者进行了一项回顾性队列研究。主要结局是30天死亡率。我们使用多变量逻辑回归来确定与30天死亡率独立相关的术前因素。
研究队列包括918例患者；他们的中位年龄为70岁（四分位间距：59 - 80岁），62%为女性，90%为白人。AMI开放血管重建术后30天死亡率为32%，具体而言，栓子切除术术后为35%，血栓内膜切除术术后为31%，肠系膜旁路术后为28%。需要同时进行肠切除术的患者死亡率更高（分别为38%和29%，P < 0.01）。与30天死亡率最密切相关的术前因素是播散性癌症（比值比 = 8.8，95%置信区间 = 2.4 - 32，P = 0.001）。其他与死亡率独立相关的因素包括肾功能不全、术前插管、术前输血、糖尿病、术前国际标准化比值升高、术前白细胞计数升高和年龄增加。
在这项使用真实世界、全国性队列的回顾性队列研究中，AMI开放血管重建术与高死亡率相关，近三分之一的患者在手术后30天内死亡。确定与30天死亡率独立相关的因素，特别是播散性癌症、术前肾功能不全和术前白细胞计数升高，是术前风险分层的重要工具。
