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Factors associated with the need for long-term total parenteral nutrition in survivors of acute superior mesenteric artery occlusion

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Acute superior mesenteric artery (SMA) occlusion is an uncommon condition associated with high mortality. If extensive bowel resection is performed for patients with acute SMA occlusion and the patient survives, long-term total parenteral nutrition (TPN) may be needed due to short bowel syndrome. This study examined factors associated with the need for long-term TPN after the treatment of acute SMA occlusion.

Methods

We retrospectively analyzed 78 patients with acute SMA occlusion. Patients were abstracted from a Japanese database from institutions with at least 10 patients with acute SMA occlusive disease from January 2015 through December 2020

Results

Among the initial cohort there were 41/78 survivors. Of these, 14/41 (34%) required permanent TPN who were compared with those who did not require long-term TPN (27/41, 66%). Compared to patients in the non-TPN group, those in the TPN group had significantly shorter remaining small intestine (90.7 cm vs. 218 cm, P<0.01), more patients with time from onset to intervention >6 hours (P=0.02), pneumatosis intestinalis on enhanced computed tomography scan (P=0.04), ascites (Odds Ratio 11.6, P<0.01), and a positive smaller superior mesenteric vein sign (P= 0.03). These were considered significant risk factors for needing long-term TPN. Age, gender, underlying disease, presence of peritoneal sign, presence of shock requiring vasopressors, site of obstruction (proximal vs. distal), and initial treatment (surgery vs. interventional radiology vs. thrombolytic therapy) were not significantly different between the two groups. Long-term TPN was significantly associated with longer hospital stay (52 vs. 35 days, P=0.04). Multivariate analysis identified the presence of ascites as an independent risk factor for needing long-term TPN.

Conclusion

The need for permanent TPN after treatment of acute SMA occlusion is significantly associated with longer hospital stay, longer time to intervention, and characteristic imaging findings (pneumatosis intestinalis, ascites, Smaller SMV sign). Ascites is an independent risk factor.

Level of evidence

III.

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Funding

This work was supported by the Japan Society of Abdominal Emergency Medicine [grant numbers 21–2].

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Authors and Affiliations

  1. Department of General Surgery, Marshall University School of Medicine, 1600 Medical Center Drive, Suite 2500, Huntington, WV, 25701, USA

    Yuki Nakao & Errington Thompson

  2. Department of Gastroenterology and General Surgery, Jichi Medical University, 3311-1, Shimotsukeshi Yakushiji, Tochigi, 329-0498, Japan

    Hideki Sasanuma, Naohiro Sata & Alan Lefor

  3. Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, 2-12-7, Itabashiku, Tokyo, 174-0051, Japan

    Nobumi Tagaya

  4. Department of Surgery, Saiseikai Utsunomiya Hospital, 911-1, Utsunomiyashi, Tochigi, 321-0974, Japan

    Kenji Matsumoto

  5. Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyoku, Tokyo, 113-8603, Japan

    Taiki Mizobuchi

  6. Department of Surgery, Kurume University, 67, Kurumeshi Asahicho, Fukuoka, 830-0011, Japan

    Fumiki Koga

Authors
  1. Yuki Nakao
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  2. Hideki Sasanuma
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  3. Naohiro Sata
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  7. Fumiki Koga
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  8. Errington Thompson
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  9. Alan Lefor
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Contributions

YN was involved in literature search, data collection, study design, data analysis, data interpretation, writing; HS helped in study design, data interpretation, writing critical revision; NS contributed to data interpretation, critical revision; NT, KM, TM, and FK were involved in data collection; ET helped in writing, critical revision, AL contributed to data interpretation, writing, critical revision.

Corresponding author

Correspondence to Yuki Nakao.

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Conflict of interest

We have no conflicts of interest to disclose.

Ethical approval and consent to participate

The institutional review board of the study hospital provided a waiver for retrospective data collection.

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Nakao, Y., Sasanuma, H., Sata, N. et al. Factors associated with the need for long-term total parenteral nutrition in survivors of acute superior mesenteric artery occlusion. Eur J Trauma Emerg Surg 49, 2025–2030 (2023). https://doi.org/10.1007/s00068-023-02281-1

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  • DOI: https://doi.org/10.1007/s00068-023-02281-1

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