Acute mesenteric ischemia: The importance of early surgical consultation

Islam G. Eltarawy, Yasser M. Etman, Mazen Zenati, Richard L. Simmons, Matthew R. Rosengart

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Acute mesenteric ischemia continues to be associated with high mortality. We hypothesized that delays in surgical consultation and operation are independently associated with increased mortality and sought to identify modifiable characteristics associated with delayed management. We conducted a retrospective cohort study of 72 patients diagnosed with acute mesenteric ischemia. Twenty-six (36%) patients died, of which 14 (54%) had care withdrawn. Delay in operation (>6 hours after surgical consultation) was associated with increased mortality (adjusted OR 3.7; 90% CI, 1.1-12). For patients for whom care was not withdrawn, delay in surgical consultation (>24 hours after disease onset) was associated with increased mortality (adjusted OR, 9.4; 90% CI, 1.3-65), as was delay in operation (adjusted OR, 4.9; 90% CI, 1.1-22). For those managed medically, early surgical consultation was associated with improved mortality (Odds Ratio [OR], 0; 90% Confidence Interval [CI], 0-0.34). Patients with delayed surgical consultation were more likely to have abdominal distension, elevated lactate concentration, acute renal failure, vasopressor administration, and a lack of abdominal pain. The acquisition of CT imaging trended toward an association with delayed surgical consultation (P = 0.06). We conclude that early surgical consultation is associated with improved outcome even for patients managed without operative intervention, and that CT imaging may delay appropriate care.

Original languageEnglish
Pages (from-to)212-219
Number of pages8
JournalAmerican Surgeon
Volume75
Issue number3
StatePublished - Mar 2009

Fingerprint

Dive into the research topics of 'Acute mesenteric ischemia: The importance of early surgical consultation'. Together they form a unique fingerprint.

Cite this