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Prognostic Factors of Preoperative Examinations for Non-occlusive Mesenteric Ischemia: A Multicenter Retrospective Project Study Conducted by the Japanese Society for Abdominal Emergency Medicine

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Abstract

Background

Non-occlusive mesenteric ischemia (NOMI) has a high mortality rate, but the analyses of preoperative prognostic factors for improving survival in patients suspected of having NOMI are scarce. We aimed to analyze the prognostic factors of preoperative examinations for NOMI.

Methods

The clinical data of 224 patients with NOMI were retrospectively collected for a multicenter survey. Clinicophysiological factors were compared between the survivors and non-survivors (N = 107/117) and between the operative and non-operative cases (N = 180/44) by univariate analysis using chi-square test and multivariate analysis using Cox proportional hazard models. In the operative cases, the prognostic operative factors were also analyzed.

Results

The overall mortality rate for NOMI was 52.2%. There were 129 male and 95 female patients. The mean age was 71.23 (14–94) years. Univariate analysis showed that cardiovascular complication, shock, abdominal pain, average blood pressure, systemic inflammatory response syndrome, aspartic aminotransferase, alanine transaminase, creatine phosphokinase, lactate dehydrogenase, base excess, prothrombin time-international normalized ratio, D-dimer, and fibrinogen degradation products were independent prognostic factors. Multivariate analysis showed that average blood pressure and base excess were independent prognostic factors. Among patients undergoing surgery, those with bowel resection had better prognosis than those without bowel resection, but those with long bowel resection had worse prognosis than those with short resection. Additional postoperative treatment was not effective compared with operation alone (P = 0.011).

Conclusions

Prognostic factors of preoperative examinations for NOMI were average blood pressure and base excess. Patients with long bowel resection should be carefully monitored owing to their poor prognosis.

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Acknowledgments

This study was a nationwide multi-institutional analysis of NOMI conducted by the board members of the Japanese Society for Abdominal Emergency Medicine. The authors thank the following participating institutions: Medical Emergency Center Kinki University, Yashima General Hospital, Ebina General Hospital, Department of Gastroenterological Surgery Hirosaki University, Department of Surgery Nippon Medical School Chiba Hokusoh Hospital, Hyogo Prefectural Awaji Medical Center, Department of Gastroenterological Surgery II, Hokkaido University, National Hospital Organization Chiba Medical Center, Department of Gastroenterology Toho University Ohashi Medical Hospital, Advanced Emergency Medical Service Center Kurume University, Department of General and Mammary Endocrine Surgery Sapporo Medical University, Public Toyooka Hospital, Trauma and Resuscitation Saga University, Department of Inflammatory Bowel Disease, Division of Surgery Hyogo College of Medicine, First Department of Surgery Dokkyo Medical University, Department of Surgery and Science, Graduate School of Medical Sciences Kyushu University, Department of Surgery Showa General Hospital, Department of Colorectal and Proctological Surgery Juntendo University, Department of Surgery Jikei University, Advanced Critical Care Center, Radiology Department Gifu University, Department of Gastrointestinal Surgery, Saitama Medical University, First Department of Surgery Yamagata University, Emergency General Center Higashisumiyoshi Morimoto Hospital, Department of Digestive and General Surgery St. Marianna University School of Medicine, General Medical Treatment/Emergency Center Toho University Omori Medical Center, Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine.

Funding

No financial support was received for this study.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Ibaraki, 300-0395, Japan

    Shuji Suzuki

  2. Department of Radiology, Teikyo University Graduate School of Medicine, Tokyo, Japan

    Hiroshi Kondo

  3. Department of Radiology, Tokyo Metropolitan University, Tokyo, Japan

    Akira Furukawa

  4. Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan

    Kentaro Kawai

  5. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Takafumi Yukaya

  6. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan

    Takashi Shimazui

  7. Department of Surgery, Shiga University of Medical Science, Shiga, Japan

    Masaji Tani

  8. Department of Gastroenterological Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Masakazu Yamamoto

Authors
  1. Shuji Suzuki
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  2. Hiroshi Kondo
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  3. Akira Furukawa
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  4. Kentaro Kawai
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  5. Takafumi Yukaya
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  6. Takashi Shimazui
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  7. Masaji Tani
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  8. Masakazu Yamamoto
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Corresponding author

Correspondence to Shuji Suzuki.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical conduct

This study was approved by the research Ethics Committee of Ibaraki Medical Center, Tokyo Medical University (acceptance number: 15–9) and the research Ethics Committee of Japanese Society for Abdominal Emergency Medicine. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration. This article does not contain any studies with animals performed by any of the authors.

Informed consent

The requirement for obtaining written informed consent from each patient was waived because of the retrospective study design.

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Suzuki, S., Kondo, H., Furukawa, A. et al. Prognostic Factors of Preoperative Examinations for Non-occlusive Mesenteric Ischemia: A Multicenter Retrospective Project Study Conducted by the Japanese Society for Abdominal Emergency Medicine. World J Surg 44, 3687–3694 (2020). https://doi.org/10.1007/s00268-020-05678-w

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  • DOI: https://doi.org/10.1007/s00268-020-05678-w

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