Experience and perioperative factors affecting the results of acute mesenteric ischemia. Results from a Chilean tertiary referral center

Introduction and objective: acute mesenteric ischemia has a low incidence but high mortality. The results of this disease are not well reported in developing countries. This study aims to describe the results of a Chilean tertiary university center and the factors that affect its morbidity and mortality. Material and methods: retrospective analysis of all patients undergoing emergency surgery for acute mesenteric ischemia between 2016 and 2021 at the hospital cl & iacute;nico universidad de chile. Patients managed without surgery were excluded. Demographic characteristics, perioperative factors, details of the first surgery, 30 -day mortality, and hospital stay, among others, were analyzed. Results: 32 patients were included. The median age was 73.5 years (45-92). The most frequent comorbidities were arterial hypertension (62.5 %), diabetes mellitus (28.1 %) and known cardiovascular disease 34.4 % (acute myocardial infarction, chronic angina, cerebrovascular accident, acute limb ischemia, peripheral arterial occlusive disease). 40.6 % had a thrombotic arterial cause, 18.8 % embolic arterial, 25 % thrombotic venous and 15.6 % non -occlusive (NOMI). The most frequent reason for consultation was abdominal pain (84.4 %). In the first surgical intervention, 81.3 % required intestinal resection, with an anastomosis performed in 53.1 %. 25 % were revascularized, with a vascular surgeon on the surgical team in 65.6 %. The median hospital stay was 21 (2-129) days. The median time from the emergency department to surgery was 10.75 hours (4.75-196). Mortality at 30 days was 40.6 %, with no differences between etiologies. There was a trend of lower mortality when a vascular surgeon participated in the surgical team (OR 0.74; CI 0.17-3.24) or when an intestinal anastomosis was performed (OR 0.62; CI 0.15-2, 58); while a higher mortality was observed among those > 70 years of age (OR 5.6, 95 % CI 1.15-27.37), and patients with hyperlactatemia (OR 1.75; CI 0.35-8.71) or acidosis (OR 1.54; CI 0.31-7.72), although these results did not reach statistical significance. Conclusions: mortality is consistent with that reported internationally. There is a trend of lower mortality among patients operated on by a vascular surgeon or when an anastomosis is performed, the latter probably due to a better physiological/intestinal state; with higher mortality in patients with hyperlactatemia and acidosis. The greatest limitation of this study is the small sample, consistent with its low incidence.