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Epidemiology of Acute Mesenteric Ischemia: A Population-Based Investigation

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Abstract

Background

There is a lack of population-based studies on acute mesenteric ischemia (AMI). We have therefore performed a nationwide epidemiological study in Estonia, addressing incidence, demographics, interventions and mortality of AMI.

Methods

A retrospective population-based review was conducted of all adult cases of AMI accrued from the digital Estonian Health Insurance Fund and Causes of Death Registry for 2016–2020 based on international classification of diseases (ICD-10) diagnostic codes and procedure codes (NOMESCO).

Results

Overall, 577 cases of AMI were identified—an annual incidence of 8.7 per 100,000. The median age was 79 (range 32–104) and 57% were female. Predominating comorbidities included hypertensive disease (81%), atherosclerosis (67%), and atrial fibrillation (52%). The majority of cases (60%) were caused by superior mesenteric artery occlusion (thrombosis 54%, embolism 12%, and unclear 34%). Inferior mesenteric artery occlusion occurred in 7%, non-occlusive mesenteric ischemia in 7%, venous thrombosis in 4%, whereas the type remained unclear in 21% of cases. 40% of patients received intervention (revascularization and/or intestinal resection) and 13% active non-operative treatment. In 21% an exploratory laparotomy or laparoscopy revealed unsalvageable bowel prompting end-of-life care, which was the only management in a further 25% of cases.

Conclusions

The population-based annual incidence of AMI in Estonia was 8.7 per 100,000 during the study period. The overall hospital mortality and 1 year mortality were 64% and 74%, respectively. In the 53% of patients who received active treatment hospital mortality was 32% and 1 year all-cause mortality was 51%.

Trial registration

ClinicalTrials.gov Identifier NCT04867499.

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Data availability

Study data can be made available on a reasonable request for future collaborative analyses.

Abbreviations

AMI:

Acute mesenteric ischemia

SMA:

Superior mesenteric artery

IMA:

Inferior mesenteric artery

SMV:

Superior mesenteric vein

NOMI:

Non-occlusive mesenteric ischemia

EHIF:

Estonian Health Insurance Fund

ECDR:

Estonian causes of death registry

ICD:

International classification of diseases

BE:

Base excess

WBC:

White blood cells count

ED:

Emergency department

EOLC:

End-of-life care

IQR:

Interquartile range

MI:

Myocardial infarction

TE:

Thromboembolic

IR:

Interventional radiology

I-FABP:

Intestinal fatty-acid-binding protein

SM22:

Arterial smooth muscle protein

CI:

Confidence interval

NA:

Not available

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Acknowledgements

Olga Kiss, Sergei Gordienko and Martin Kivilo for helping to collect the data.

Funding

Grant PRG 1255.

Author information

Authors and Affiliations

  1. Department of Surgery, Tartu University Hospital, Tartu, Estonia

    Karri Kase & Marko Murruste

  2. Faculty of Medicine, University of Tartu, Tartu, Estonia

    Karri Kase, Kadri Tamme, Alastair Forbes, Peep Talving & Marko Murruste

  3. Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia

    Annika Reintam Blaser & Kadri Tamme

  4. Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Annika Reintam Blaser

  5. Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Tallinn, Estonia

    Peep Talving

  6. Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia

    Merli Mändul

  7. Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia

    Merli Mändul

  8. Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia

    Alastair Forbes

Authors
  1. Karri Kase
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  2. Annika Reintam Blaser
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  4. Merli Mändul
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Contributions

KK, ARB, MaM, KT and PT conceptualized the study. KK prepared all the documents and led data collection process. KK drafted the manuscript, assisted by MaM, ARB and AF. MeM performed statistical analysis. All the authors critically revised the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Karri Kase.

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Conflict of interest

The authors declare that they have no conflict to interest.

Consent for publication

Not applicable.

Consent to participate

Not applicable. Study was retrospective and Ethics Committee gave approval to do study without consent.

Ethical approval

Approval for the study was obtained from the Research Ethics Committee of the University of Tartu (number 345 M-5) and from the Estonian Committee on Bioethics and Human Research (number 1.1-12/1238).

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Kase, K., Reintam Blaser, A., Tamme, K. et al. Epidemiology of Acute Mesenteric Ischemia: A Population-Based Investigation. World J Surg 47, 173–181 (2023). https://doi.org/10.1007/s00268-022-06805-5

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