Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia: A multicenter retrospective cohort study

Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis.In this multicenter retrospective study, we reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and non-survivor groups, and statistical analysis was performed to determine clinical physiological factors.Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the non-survivor group. Univariate analysis revealed a significant difference in body mass index (P<0.001), hypoglycemia (P=0.0012), previous cardiovascular surgery (P=0.0019), catecholamine use (P<0.001), SOFA score (P<0.001), platelet count (P=0.0023), and lactate level (P<0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% confidence interval 1.94-280.00; P=0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score ≥10.This study confirmed that a SOFA score of ≥10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches ≥10.