Acute Mesenteric Ischemia: Preexisting Comorbidity Determines Short-Term Outcome and Quality of Life in Long-Term Survivors

Abstract

<b><i>Introduction:</i></b> Acute mesenteric ischemia (AMI), either arterial or venous, is still a devastating disease with poor prognosis. It is unknown, whether AMI is associated with impaired quality of life (QoL) in long-term survivors. <b><i>Material and Methods:</i></b> This retrospective analysis includes 64 patients with occlusive arterial or venous mesenteric ischemia treated operatively between 2008 and 2016 at the University Medical Center Rostock. Short-term outcome with focus on comorbidities was measured by the Charlson comorbidity index (CCI) an instrument that operationally measures comorbidity based on 17 clinical parameters including age. Operative outcome in view of enterostomy placement and long-term outcome measured as QoL by the EQ-5D in the long-term survivors were evaluated. The EQ-5D is a standardized, self-reported five-dimension QoL questionnaire built to provide a simple and generic measure of health. <b><i>Results:</i></b> Thirty-day mortality was 60.9%, and in-hospital mortality was 70.3% (<i>n</i> = 45). No patient was discharged with a stoma. Patients with a primary anastomosis after the initial operation for AMI had a high leak rate of 27% (4/15 patients) compared to no dehiscence in the group of patients who had secondary anastomosis during second or third laparotomy. The long-term survivors had significantly lower CCI compared to the 45 nonsurvivors (median 4 [3, 4, 5, 6] vs. 6 [4, 5, 6, 7]). All long-term survivors had QoL assessment. QoL score was significantly impaired compared to an age- and sex-matched reference population. This impairment was not due to disease-specific sequelae such as presence of stool deviation or intestinal failure but due to preexisting risk factors as shown by an inverse relation between the CCI and QoL score. <b><i>Conclusion:</i></b> Herein, we show for the first time that long-term QoL in patients with AMI is impaired but this impairment is not due to disease-specific aspects but rather general risk factors underlying the presence of a higher level of comorbidities at the time of AMI.

Quality of life after emergency laparotomy: a systematic review

“…The studies included consist of six prospective [ 13 – 18 ] and five retrospective [ 8 , 19 – 22 ] studies. The mean follow-up for the prospective studies was 13.7 months and 14.8 for the retrospective studies.…”

“…Prospective studies had a higher mean quality score than retrospective studies (7.7 vs 6.3 respectively). Five studies matched post-operative QoL to the pre-operative QoL of the same patient cohort [ 13 , 14 , 16 , 18 , 19 ], four studies compared the post-operative patients to a healthy reference population [ 9 , 18 , 22 , 23 ] and two studies compared those with post-operative chronic pain to patients with no post-operative pain [ 15 , 20 ] (Table 2 ).…”

“…Four studies compared the post-operative QoL with a normal healthy reference population [ 9 , 18 , 22 , 23 ]. One study provided numerical values and the other two studies displayed their results in graphical form.…”

“…In addition, three studies reported worse social function [ 8 , 15 , 19 ], three reported worse psychological items or emotions or mood [ 15 , 17 , 20 ], two reported worse energy levels or increased fatigue [ 8 , 13 ] and two reported worse pain post operatively [ 13 , 17 ]. One study showed that the length of bowel resected correlated to impairment of QoL [ 22 ]. Only one study from those included in this review reported significant improvement in all domains of QoL measured after emergency laparotomy [ 18 ].…”

Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature

“…We performed resection of the necrotic bowel and ostomy of the proximal and distal jejunum instead of one-stage intestinal anastomosis. This operation could avoid postoperative anastomotic leakage, which was reported to have an incidence of 23.4–27% after one-stage intestinal anastomosis [ 23 , 24 ]. The enteral nutrition path can be easily established through the stoma, and total nutrition can be started sooner after the operation.…”