H Mothes1, J Koeppen2, O Bayer3, M Richter4, B Kabisch5, D Schwarzkopf6, H A T Hein7, J Zanow8, T Doenst9, U Settmacher10. 1. Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: henning.mothes@med.uni-jena.de. 2. Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: jonaskoeppen@posteo.de. 3. Department of Anesthesiology and Intensive Care, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Ole.Bayer@med.uni-jena.de. 4. Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Markus.Richter@med.uni-jena.de. 5. Central Service Provider for Information Technology (IT) Services, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Bjoern.Kabisch@med.uni-jena.de. 6. Center for Sepsis Control and Care, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: daniel.schwarzkopf@med.uni-jena.de. 7. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, 3300 Oak Lawn Ave, Ste 200, Dallas, TX 75219, Dallas, USA. Electronic address: tillhein@gmail.com. 8. Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Juergen.Zanow@med.uni-jena.de. 9. Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: Doenst@med.uni-jena.de. 10. Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany. Electronic address: utz.settmacher@med.uni-jena.de.
Abstract
INTRODUCTION: Acute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia. METHODS: In a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses. RESULTS: Of 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6-49.3), and emergency operation (OR 2.6, CI95% 1.3-5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6-7.8), epinephrine (OR 2.0, CI95% 1.1-3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5-5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy. CONCLUSION: Early identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates.
INTRODUCTION: Acute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia. METHODS: In a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses. RESULTS: Of 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6-49.3), and emergency operation (OR 2.6, CI95% 1.3-5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6-7.8), epinephrine (OR 2.0, CI95% 1.1-3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5-5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy. CONCLUSION: Early identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates.