Morbidity and mortality after bowel resection for acute mesenteric ischemia

Background: Patients presenting with acute mesenteric ischemia (AMI) sufficiently advanced to require bowel resection have a high morbidity and mortality. The objective of this study was to analyze these patients to determine if certain pre- or intraoperative variables are predictive of death or complications which could then be used to develop a predictive model to aid in surgical decision-making. Methods: Patients undergoing bowel resection for AMI were identified from the American College of Surgeons' National Surgical Quality Improvement Program database (2007-2008). Multiple logistic regression analysis was performed. Results: The 861 patients identified had a median age of 69 years. Thirty-day postoperative morbidity and mortality were 56.6% and 27.9%, respectively. Pre- and intraoperative variables significantly associated with postoperative mortality (C statistic, 0.84) included preoperative do not resuscitate order, open wound, low albumin, dirty vs clean-contaminated case, and poor functional status. Pre- and intraoperative variables significantly associated with postoperative morbidity (C statistic, 0.79) included admission from chronic care facility, recent myocardial infarction, chronic obstructive pulmonary disease, requiring ventilator support, preoperative renal failure, previous cardiac surgery, and prolonged operative time. A predictive risk calculator was developed using these variables. Conclusion: Mortality and morbidity rates after bowel resection for AMI are high. A risk calculator for prediction of postoperative mortality and morbidity has been developed and awaits validation in subsequent studies.