Retrospective analysis of factors associated with mortality in acute mesenteric ischemia

Abstract

Aim: Acute mesenteric ischemia (AMI) remains one of the most lethal surgical emergencies, with persistently high mortality despite advances in diagnostic imaging and surgical management. Identification of factors associated with early mortality may improve risk stratification and clinical decision-making.

Materials and Methods: This single-center, retrospective observational study included adult patients who underwent emergency surgery for AMI over a 20-year period. Demographic characteristics, presenting symptoms, time to hospital admission, comorbidities, physical examination findings, leukocyte count, and intraoperative findings were analyzed. The primary outcome was 30-day mortality. Survivors and non-survivors were compared using univariate statistical analyses.

Results: A total of 118 patients were included, with a mean age of 64.9 ± 12.5 years; 60.2% were male. The overall 30-day mortality rate was 76.3%. Non-survivors were significantly older than survivors (66.4 ± 12.2 vs. 60.1 ± 12.4 years, p = 0.019). Delayed presentation was strongly associated with mortality: 25.0% of survivors presented within 12 hours compared with 4.4% of non-survivors, whereas presentation after 24 hours was more frequent among non-survivors (82.2% vs. 53.6%, p = 0.002). Leukocyte count categories were significantly associated with mortality (p = 0.034). The presence of massive intestinal necrosis was the strongest predictor of death, identified in 70.0% of non-survivors versus 21.4% of survivors (p < 0.001). Presenting symptoms, physical examination findings, atrial fibrillation, and comorbidity status were not significantly associated with mortality.

Conclusion: Mortality in acute mesenteric ischemia remains exceedingly high and is primarily determined by delayed presentation and the extent of intestinal ischemia. Early diagnosis, prompt surgical intervention, and aggressive management are essential to improving outcomes in this devastating condition.