Int J Surg. 2023 Sep 14. doi: 10.1097/JS9.0000000000000733. Online ahead of print.
BACKGROUND: 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.
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.