Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia
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ORIGINAL ARTICLE
Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia Akira Endo 1 & Fumitaka Saida 2 & Yuzuru Mochida 3 & Shiei Kim 4 & Yasuhiro Otomo 1 & Daisuke Nemoto 5 & Hisahiro Matsubara 6 & Shigeru Yamagishi 7 & Yoshinori Murao 8 & Kazuki Mashiko 9 & Satoshi Hirano 10 & Kentaro Yoshikawa 11 & Toshiki Sera 12 & Mototaka Inaba 13 & Hiroyuki Koami 14 & Makoto Kobayashi 15 & Kiyoshi Murata 16 & Tomohisa Shoko 2 & Noriaki Takiguchi 17 Received: 11 March 2020 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background There has been insufficient evidence regarding a treatment strategy for patients with non-occlusive mesenteric ischemia (NOMI) due to the lack of large-scale studies. We aimed to evaluate the clinical benefit of strategic planned relaparotomy in patients with NOMI using detailed perioperative information. Methods We conducted a multicenter retrospective cohort study that included NOMI patients who underwent laparotomy. Inhospital mortality, 28-day mortality, incidence of total adverse events, ventilator-free days, and intensive care unit (ICU)–free days were compared between groups experiencing the planned and on-demand relaparotomy strategies. Analyses were performed using a multivariate mixed effects model and a propensity score matching model after adjusting for pre-operative, intraoperative, and hospital-related confounders. Results A total of 181 patients from 17 hospitals were included, of whom 107 (59.1%) were treated using the planned relaparotomy strategy. The multivariate mixed effects regression model indicated no significant differences for in-hospital mortality (61 patients [57.0%] in the planned relaparotomy group vs. 28 patients [37.8%] in the on-demand relaparotomy group; adjusted odds ratio [95% confidence interval] = 1.94 [0.78–4.80]), as well as in 28-day mortality, adverse events, and ICU-free days. Significant reduction in ventilator-free days was observed in the planned relaparotomy group. Propensity score matching analysis of 61 matched pairs with comparable patient severity did not show superiority of the planned relaparotomy strategy. Conclusions The planned relaparotomy strategy, compared with on-demand relaparotomy strategy, did not show clinical benefits after the initial surgery of patients with NOMI. Further studies estimating potential subpopulations who may benefit from this strategy are required. Keywords Acute care surgery . Acute mesenteric ischemia . Open abdominal management . Surgery . Critical care
Introduction Non-occlusive mesenteric ischemia (NOMI) is generally defined by mesenteric ischemia without occlusion of the mesenteric arteries.1 It often occurs in critically ill patients with Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04792-3) contains supplementary material, which is available to authorized users. * Akira Endo [email protected] Extended author information available on the last page of the a
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