Prognostic factors in acute mesenteric ischemia and evaluation with multiple logistic regression analysis effecting morbidity and mortality

Background: Acute mesenteric ischemia (AMI) is a catastrophic abdominal emergency characterized by sudden critical interruption to the intestinal blood flow which commonly leads to bowel infarction and death. AMI still has a poor prognosis with an in-hospital mortality rate of 50-69%. This high mortality rate is related to the delay in diagnosis which is often difficult and overlooked. Early intervention is crucial and gives a chance for intestinal viability. Methods: The charts of 140 patients who were hospitalized with AMI between May 1997 and August 2013 in Ege University Faculty of Medicine, Department of General Surgery were retrospectively reviewed. Demographical and clinical features of patients constituting the best predictors of morbidity and mortality were evaluated with Multiple Logistic Regression analysis by Enter method after adjustment for all possible confounding factors. Results: Out of 140 patients, 77 were men (55%) and 63 were women (45%). The mean age was 66.6 +/- 14.5 (16-94) years. Demographical findings, comorbidities, ASA scores, drugs used for mesenteric ischemia and diagnostic imaging materials were summarized. The most common comorbidities were cardiac problems (42.9%). Twenty-seven (19.3%) patients had diabetes mellitus. The median ASA score was 3. Abdominal computed tomography (CT) was the most commonly used imaging modality and it was performed in 119 (85%) patients. Twenty-five (17.9%) patients were in shock and 48 (34.3%) had acidosis. The time of delay between the onset of acute abdominal pain to surgery was <12 hours in 14 patients (10.0%), 12 to 24 hours in 46 patients (32.9%), and >24 hours in 80 patients (57.1%). The most common etiology in AMI was thrombus, in 69 patients (49.3%). The most affected or involved organ was both small and large bowel - in 80 patients (57.1%) in total. The most commonly performed surgery was small bowel resection - in 42 patients (30%).As many as 127 (90.7%) of all patients underwent surgery and 18 (12.9%) patients underwent a second-look laparotomy. Small bowel length of less than 100 cm was recorded in 46 patients (32.9%). The length of hospital stay was 7 days (1-90 days). Morbidities were found in 51 patients (36.4%) and death in 74 patients (52.9%). Conclusion: The purpose of this study was to evaluate the prognostic factors of AMI to better understand it and optimize both medical and surgical management with improvement of treatment results. We suggested that the diagnosis of AMI should be based on suspicion of a clinician only and that laparotomy should be performed as soon as possible, before the onset of the clinical signs of peritonitis. Age and time of delay between the onset of acute abdominal pain and surgery longer than 24 hours are the most important prognostic factors for mortality in patients presenting with shock and acidosis.