The analysis of the predictive factors of mortality in patients with acute mesenteric ischemia

Background: The acute mesenteric ischemia is a rare life-threatening surgical condition, followed by high mortality and morbidity rate. Disparate etiologies and nonspecific symptoms make the diagnosis and the surgery delayed, which leads to a higher mortality rate (60-80%).

Methods: This research was designed as a retrospective study, including a total of 86 patients operated for acute mesenteric ischemia between 2014 and 2020 at the 2nd Department of Surgery in Mureș County Emergency Clinical Hospital. We recorded and analyzed the demographic, clinical, pre-operative radiological and laboratory, and surgical findings of the patients. Results: We analyzed the findings of 86 patients (59,3% men, 40,7% women), the mortality rate was 77,9% (77% in women, 78% in men), and the average age was 76,81 years. The youngest patient was 39 years old and the oldest was 96 in the moment of the diagnosis. The mortality rate was higher (93%) in patients, who suffered just an explorative laparotomy surgery (in 50% of the cases, p=0,001, Chi-squared test). The presence of the peritonitis (12 cases) had a negative impact on the survival rate, every patient who had peritonitis described on the computed tomography died after the surgical intervention (p=0,047, Chi-square test). Statistically, there was not a positive relationship between the time spent in the Emergency Room and the mortality rate, but this time was much longer in the group of patients who died after the surgery, 408,22 minutes, compared to the group of the patients who survived, 352,47 minutes (p=0,431, T-test). The survival rate was higher in patients who had abdominal surgery in the personal history (p=0,021, Chi-square test).

Conclusions: The symptoms and the paraclinical findings of patients with acute mesenteric ischemia are not specific, so the fast radiological examinations and the optimal time for the surgical intervention represent the key of the improvement of the survival rate.