Abstract
Purpose
Acute mesenteric ischemia (AMI) remains a therapeutic challenge, with high mortality and limited data on long-term prognosis. This study aimed to describe postoperative and survival outcomes following surgery for AMI and identify factors associated with in-hospital mortality.
Methods
A retrospective study was conducted on adult patients (> 18 years) undergoing surgery for AMI between January 2010 and August 2024 at two tertiary centers. Demographic, clinical, and operative data were collected. The primary outcome described survival patterns following discharge. Secondary outcomes included postoperative outcomes and variables associated with in-hospital mortality.
Results
Among 104 patients with AMI, 24 (23.1%) underwent arterial revascularization (22 with concurrent bowel resections) and 8 (7.7%) had non-therapeutic laparotomies. The median number of surgical explorations was 2 per patient during the index admission. In-hospital mortality was 50%, with most occurring in the first postoperative week. Univariate analysis showed non-survivors were significantly older, exhibited higher Charlson Comorbidity Index scores, and higher serum creatinine levels. Additionally, non-survivors more frequently demonstrated pneumatosis intestinalis on CT scan, had a longer bowel segment resected and were more likely to have arterial thrombosis as the underlying etiology. Five-year survival post-discharge was 74.8%, with most deaths occurring within the first 12 months. Sepsis was the leading cause of death post-discharge, followed by cardiovascular disease.
Conclusion
In-hospital mortality among patients with AMI is substantial and is associated with advanced age, increased comorbidity burden, arterial etiology, and extensive bowel resection. Survival beyond hospital discharge carries a reasonable prognosis.
Supplementary Information
The online version contains supplementary material available at 10.1007/s00423-025-03852-z.
Keywords: Acute mesenteric ischemia, Bowel necrosis, Mesenteric arterial occlusion, Mortality, Post-discharge prognosis
Introduction
Acute mesenteric ischemia (AMI) is a rare yet life-threatening surgical emergency that results from a sudden interruption of mesenteric blood flow and subsequent bowel infarction, with an estimated incidence of only 6 per 100,000 person-years [1]. Existing literature is constrained by small cohort sizes, and data on long-term outcomes remain scarce [2, 3]. Despite advancements in surgical care, AMI continues to carry somber outcomes, with mortality rates as high as 60% [1, 4, 5]. Unfavorable outcomes are attributed to advancing age, higher comorbidity burden, nonspecific symptoms and lack of precise diagnostic tools. These factors often delay presentation and intervention, thereby precipitating a cascade of multi-organ dysfunction [2, 6]. The objective of this study was to report short- and long-term survival after surgery of a cohort of patients with AMI in the context of contemporary surgical practice, while identifying factors associated with in-hospital mortality.
Materials and methods
Study design and setting
This retrospective study was conducted between January 2010 and August 2024 at two tertiary referral centers, serving a population of 2 million in the State of Kuwait. The study received approval from the institutional ethical committee of the Ministry of Health, and the requirement for written consent was waived due to its retrospective nature.
This cohort study has been reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria [7]. The STROBE checklist is included in the Supplemental Digital Content.
Participants
The study included all consecutive patients with a confirmed diagnosis of AMI as identified from electronic hospital records. AMI was defined as Grade II or higher according to the American Association for the Surgery of Trauma (AAST) severity grading scale, based on preoperative computed tomography (CT) scan and intraoperative findings [8]. All patients presenting with suspected AMI had basic laboratory investigations and a CT scan with intravenous contrast. Surgical exploration was performed when imaging suggested or confirmed AMI. Patients presenting with peritonitis and shock, who did not respond to resuscitative measures, underwent surgical exploration without a CT scan. The etiology of AMI was categorized as arterial embolism, arterial thrombosis, venous thrombosis, and non-occlusive mesenteric ischemia (NOMI) based on preoperative CT scans and confirmed intraoperatively. All patients received perioperative broad-spectrum antibiotics in addition to systemic anticoagulation, unless contraindication.
Exclusion criteria
Patients who did not undergo surgical intervention, those who underwent laparotomy for suspected mesenteric ischemia with normal intraoperative findings, and those diagnosed with bowel infarction secondary to other causes were excluded from the analysis.
Data collection
Data were extracted from the patient’s hospital records, operating room and discharge database and were retrospectively analyzed during the study period. The collected data included patients’ demographics, clinical characteristics at presentation, baseline laboratory values including a complete blood count, serum creatinine and lactate, and CT scan findings. Associated comorbidities were quantified and reported according to the Charlson Comorbidity Index (CCI) [9]. Laboratory tests and CT scans were obtained upon hospital presentation or within 24 h prior to surgery. Intraoperative details collected included the surgical procedure, extent of bowel infarction and length of bowel resected as documented in the specimen pathology report. Postoperative outcome data were collected until the patients were discharged from the hospital and followed up in the outpatient surgical department, with a minimum follow-up period of 30 days post-discharge. For overall survival, data were obtained from patients’ hospital records, including last recorded visit during the study period.
Outcomes measured
The primary outcome of this study was to report survival data of AMI patients following surgery. Secondary outcomes included identifying associations with in-hospital mortality. Postoperative outcome variables included operative details, length of bowel resected, length of ICU stay, overall length of hospital stay (LOS), postoperative complications stratified by organ system and Clavien-Dindo classification [10], unplanned readmission, and in-hospital mortality. In-hospital mortality was defined as death occurring during the index admission. Patients were further categorized into survivors and non-survivors, to describe associations with in-hospital mortality. Demographic, clinical, and perioperative characteristics were compared between the two groups. Overall survival was reported from the time of hospital discharge to the end of the study period.
Statistical methods
Continuous variables were reported as mean and standard deviation (SD) or median and interquartile range (IQR) for skewed variables and compared using the Mann-Whitney U test. Categorical variables were expressed as frequencies (percent) and compared with the Fisher’s exact test. Survival analysis was conducted using the Kaplan-Meier method to estimate survival probabilities during the study period and censoring was accounted for. The survival analysis was further stratified by etiology and compared using the log-rank test. Statistical analyses were performed using the software IBM SPSS Statistics version 29.0.2.0 (IBM Corp., Armonk, NY). P values < 0.05 were considered statistically significant.
Results
Demographics and perioperative characteristics
Between January 2010 and August 2024, there were 104 patients with confirmed AMI who met the inclusion criteria. Table 1 summarizes the patients’ preoperative characteristics. The mean age was 65.4 ± 16.3 years, and 59.6% of the patients were male. Most patients (69.2%) suffered from hypertension, followed by other cardiovascular diseases, with 26.9% having a history of atrial fibrillation.
Table 1.
Preoperative characteristics of acute mesenteric ischemia patients
| Variable | Acute Mesenteric Ischemia N = 104 |
|---|---|
| Demographic | |
| Age (mean ± SD, years) | 65.4 (± 16.3) |
| Sex (n, %) | |
| Male | 62.0 (59.6%) |
| Female | 42.0 (40.4%) |
| Charlson Comorbidity Index (n, %) | |
| 0 | 26.0 (25.0%) |
| 1 | 20.0 (19.2%) |
| 2 | 16.0 (15.4%) |
| 3 and above | 42.0 (40.4%) |
| Hypertension | 72 (69.2%) |
| Atherosclerosis | 39 (37.5%) |
| Atrial Fibrillation | 28 (26.9%) |
| Ischemic Heart Disease | 30 (28.8%) |
| Congestive Heart Failure | 18 (17.3%) |
| Peripheral Vascular Disease | 13 (12.5%) |
| Diabetes Mellitus | 48 (46.2%) |
| Chronic Renal Disease | 12 (11.5%) |
| Presentation | |
| Symptoms Duration [median (IQR), hours] | 72.0 (24.0–96.0) |
| Temperature (mean ± SD, °C) | 36.9 (± 0.5) |
| Mean Arterial Pressure (mean ± SD, mmHg) | 101.6 (± 48.6) |
| Heart Rate (mean ± SD, beat per minute) | 102.0 (± 24.5) |
| Laboratory Investigations | |
| White Blood Cell count [median (IQR), × 109/L] | 18.0 (11.8–23.8) |
| Hemoglobin [median (IQR), g/L] | 133.0 (117.0–146.0) |
| Platelets [median (IQR), × 109/L] | 265.0 (197.0–359.0) |
| Lactate [median (IQR), mmol/L] | 3.0 (1.9–4.4) |
| Urea [median (IQR), mmol/L] | 10.6 (5.4–15.3) |
| Creatinine [median (IQR), µmol/L] | 126.0 (78.0 −168.0) |
| CT Scan Findings | |
| Free Air (n, %) | 7.0 (7.2%) |
| Free Fluid (n, %) | 27.0 (27.8%) |
| Pneumatosis Intestinalis (n, %) | 13.0 (13.4%) |
| Bowel Wall Thickening (n, %) | 46.0 (44.2%) |
| Bowel Wall Low Enhancement (n, %) | 63.0 (60.6%) |
| Porto-Mesenteric Gas (n, %) | 7.0 (7.2%) |
Upon initial presentation, patients exhibited a mean body temperature of 36.9 °C (± 0.5), heart rate of 102 beats per minute (± 24.5), and a mean arterial pressure (MAP) of 101.6 mmHg (± 48.6); only 7 patients (6.3%) presented with a MAP < 65 mmHg. The median duration of symptoms prior to hospitalization was 72.0 h (IQR: 24.0–96.0). Data on preoperative lactate level was available for 88.5% of the patients, with a median of 3.0 mmol/L (IQR: 1.9–4.4). On CT scan, bowel wall thickening and low enhancement were observed in 44.2% and 60.6% of patients, respectively, while free fluid was present in 27.8%. Additionally, pneumatosis intestinalis was noted in 13.4% of cases, and both free air and porto-mesenteric gas were each identified in 7.2% of patients.
AMI perioperative outcomes
Figure 1 depicts the flowchart of patients included and operative intervention undertaken. In total 24 patients (23.1%) had a revascularization procedure. Of those, 9 patients (37.5%) had superior mesenteric artery (SMA) embolectomy, 9 patients (37.5%) had SMA thrombectomy, 5 patients (20.8%) had endovascular angioplasty, and 1 patient (4.2%) had an aorto-SMA bypass. There were only 2 patients (1.9%) who had their bowel viability restored after revascularization and no bowel resection was required. There were 32 (30.8%) patients that had infarction that extended to the colon. The median length of bowel resected was 89.0 cm (IQR: 45.0–144.8). Thirty-eight (36.5%) patients had resections exceeding 100 cm. Eight patients (7.7%) were found to have infarction of the entire small bowel where no resection was done, and palliative measures were instituted. Planned second-look laparotomy was performed for 63 (60.6%) patients. The median number of surgical explorations was 2 per patient during the index admission.
Fig. 1.
Flowchart of patients with acute mesenteric ischemia and operative intervention undertaken
Overall, half the patients died during hospitalization, with a substantial portion (40%) occurring withing the first postoperative week. For those who survived, the median length of hospital stay (LOS) was 25.5 (11.0–43.0) days. Postoperative complications occurred in 86 patients (82.7%), with infectious (51.0%), renal (30.8%) and respiratory (24.0%) complications being the most observed. The majority of complications (83.7%) were Clavien-Dindo class 3 and higher. Table 2 summarizes the intraoperative and postoperative outcomes of patients with AMI.
Table 2.
Etiology, operative details, and postoperative outcomes of acute mesenteric ischemia patients
| Variable | Acute Mesenteric Ischemia N=104 |
|---|---|
| Etiology | |
| Arterial Embolus (n, %) | 19.0 (18.3%) |
| Arterial Thrombus (n, %) | 47.0 (45.2%) |
| Venous Thrombosis (n, %) | 26.0 (25.0%) |
| Non-Occlusive Mesenteric Ischemia (n, %) | 12.0 (11.5%) |
| Operative Details | |
| Surgical procedure | |
| Bowel Resection with Anastomosis (n, %) | 68.0 (65.4%) |
| Bowel Resection without Anastomosis (n, %) | 26.0 (25.0%) |
| Revascularization Only (n, %) | 2.0 (1.9%) |
| Open and Close (n, %) | 8.0 (7.7%) |
| Colonic Involvement (n, %) | 32.0 (30.8%) |
| Length of Resected Bowel [median (IQR), cm] | 89.0 (45.0–144.8) |
| Resected Segment > 100 cm (n, %) | 38.0 (36.5%) |
| Planned Second Look (n, %) | 63.0 (60.6%) |
| Total Number of Surgeries [median (IQR)] | 2.0 (1.0–2.0) |
| Postoperative Outcomes | |
| In-Hospital Mortality (n, %) | 52.0 (50.0%) |
| Length of ICU Stay [median (IQR) days] | 6.0 (3.0–14.0) |
| Total LOS a [median (IQR) days] | 25.5 (11.0–43.0) |
| Postoperative Complications b (n, %) | 86.0 (82.7%) |
| Complications by Clavien-Dindo Classification | |
| 1 | 6 (7.0%) |
| 2 | 8 (9.3%) |
| 3 | 1 (1.2%) |
| 4 | 19 (22.1%) |
| 5 | 52 (60.4%) |
| Complications by System | |
| Cardiac (n, %) c | 5.0 (4.8%) |
| Gastrointestinal (n, %) d | 8.0 (7.7%) |
| Hematologic (n, %) e | 12.0 (11.5%) |
| Infectious (n, %) f | 53.0 (51.0%) |
| Neurologic (n, %) g | 4.0 (3.8%) |
| Renal (n, %) h | 32.0 (30.8%) |
| Respiratory (n, %) i | 25.0 (24.0%) |
| Wound (n, %) j | 3.0 (2.9%) |
| Readmission (n, %) | 19.0 (18.3%) |
a Length of stay excluding non-survivors
b Defined as the rate of one or more complications experienced by a patient
c Cardiac complications include Atrial fibrillation, supraventricular tachycardia and myocardial infarction
d Gastrointestinal complications include ileus, small bowel obstruction, anastomotic leak, and peptic ulcer disease (UGIB)
e Hematological complications include deep vein thrombosis, lower limb ischemia, disseminated intravascular coagulopathy, heparin induced thrombocytopenia and postoperative bleeding
f Infectious complications include blood stream infection, pneumonia, urinary tract infections, superficial and deep surgical site infections
g Neurological complications include seizure, subarachnoid hemorrhage, delirium, and stroke
h Renal complications include acute kidney injury, and hepatorenal syndrome
i Respiratory complications include respiratory failure, acute respiratory distress syndrome, and pulmonary edema
j Wound complications include wound dehiscence
A comparative analysis between non-survivors and survivors of AMI is depicted in Table 3. We found that older age (mean 70.2 vs. 60.7 years, p = 0.001), a higher CCI score (CCI score > 3: 57.7% vs. 23.1%, p < 0.001), an elevated WBC count (median 19.9 vs. 15.8, p = 0.030), lower hemoglobin levels (median 123.0 vs. 138.0, p = 0.008), higher creatinine levels (median 147.5 vs. 82.5, p < 0.001) and pneumatosis intestinalis on CT scan (21.3% vs. 6.0%, p = 0.037) were significantly associated with in-hospital mortality. There was no difference in the duration of symptoms prior to hospitalization among non-survivors and survivors. Arterial thrombosis was found to account for a significant portion of non-survivors (65.4% vs. 25.0%, p < 0.001), whereas venous thrombosis was more common in survivors. We did not observe a difference between non-survivors and survivors of AMI with regards to colonic involvement; however, the total length of resected bowel was significantly longer among non-survivors (median length 121.0 cm vs. 73.0 cm, p = 0.001).
Table 3.
Comparison of variables in relation to In-Hospital mortality in acute mesenteric ischemia patients
| Variable | Non-survivors N = 52 |
Survivors N = 52 |
p-value |
|---|---|---|---|
| Demographic | |||
| Age (mean ± SD, years) | 70.2 (± 15.1) | 60.7 (± 16.3) | 0.001 |
| Sex (n, %) | 0.072 | ||
| Male | 26 (50.0%) | 36 (69.2%) | |
| Female | 26 (50.0%) | 16 (30.8%) | |
| Charlson Comorbidity Index (n, %) | |||
| 0 | 5 (9.6%) | 21 (40.4%) | < 0.001 |
| 1 | 6 (11.5%) | 14 (26.9%) | |
| 2 | 11 (21.2%) | 5 (9.6%) | |
| 3 and above | 30 (57.7%) | 12 (23.1%) | |
| Hypertension | 45 (88.2%) | 27 (52.9%) | < 0.001 |
| Atherosclerosis | 29 (56.9%) | 10 (19.6%) | < 0.001 |
| Ischemic Heart Disease | 25 (48.1%) | 5 (9.6%) | < 0.001 |
| Congestive Heart Failure | 13 (25.0%) | 5 (9.6%) | 0.068 |
| Peripheral Vascular Disease | 10 (19.2%) | 3 (5.8%) | 0.720 |
| Diabetes Mellitus | 34 (65.4%) | 22 (43.3%) | 0.030 |
| Chronic Renal Disease | 9 (17.3%) | 3 (5.8%) | 0.122 |
| Presentation | |||
| Symptoms duration | 0.822 | ||
| < 24 h | 14 (30.4%) | 13 (27.7%) | |
| > 24 h | 32 (69.6%) | 34 (72.3%) | |
| Temperature (mean ± SD, °C) | 37.0 (± 0.6) | 36.8 (± 0.4) | 0.208 |
| Mean Arterial Pressure (mean ± SD, mmHg) | 95.9 (± 27.3) | 106.6 (± 61.6) | 0.498 |
| Heart Rate (mean ± SD, beat per minute) | 102 (± 25.8) | 101.8 (± 23.5) | 0.938 |
| Laboratory Investigations | |||
| WBC [median (IQR), × 109/L] | 19.9 (11.6–26.6) | 15.8 (11.9–20.0) | 0.030 |
| Hemoglobin [median (IQR), g/L] | 123.0 (102.0–137.0) | 138.0 (122.3–148.0) | 0.008 |
| Platelets [median (IQR), × 109/L] | 265.0 (190.0–359.0) | 264.5 (200.0–363.5) | 0.823 |
| Lactate [median (IQR), mmol/L] | 3.3 (2.0–6.0) | 2.4 (1.8–3.9) | 0.088 |
| Urea [median (IQR), mmol/L] | 13.3 (8.9–19.0) | 6.9 (4.1–12.2) | < 0.001 |
| Creatinine [median (IQR), µmol/L] | 147.5 (93.8–201.0) | 82.5 (73.5–133.8) | < 0.001 |
| CT Scan findings | |||
| Free Air (n, %) | 6 (12.8%) | 1 (2.0%) | 0.054 |
| Free Fluid (n, %) | 12 (25.5%) | 15 (30.0%) | 0.657 |
| Pneumatosis Intestinalis (n, %) | 10 (21.3%) | 3 (6.0%) | 0.037 |
| Bowel Wall Thickening (n, %) | 14 (42.4%) | 35 (71.4%) | 0.012 |
| Bowel Wall Low Enhancement (n, %) | 26 (78.8%) | 37 (75.5%) | 0.795 |
| Porto-Mesenteric Gas (n, %) | 7 (14.9%) | 0 (0.0%) | 0.005 |
| Etiology (n, %) | |||
| Arterial Embolism | 10 (19.2%) | 9 (17.3%) | < 0.001 |
| Arterial Thrombosis | 34 (65.4%) | 13 (25.0%) | |
| Venous Thrombosis | 2 (3.8%) | 24 (46.2%) | |
| Non-Occlusive Mesenteric Ischemia | 6 (11.5%) | 6 (11.5%) | |
| Operative Details | |||
| Length Of Resected Bowel [median (IQR), cm] | 121.0 (69.0–194.0) | 73.0 (34.8–110.3) | 0.001 |
| Colonic Involvement (n, %) | 19 (44.2%) | 13 (27.7%) | 0.125 |
Survival outcomes stratified by etiology are shown in Table 4. Over the course of the study period, 52 patients were successfully discharged from the hospital on oral diet and not requiring parenteral nutrition; among these individuals, 11 (21.2%) patients died due to other unrelated causes with sepsis being the most frequently identified cause of death (n = 5). Cardiovascular disease accounted for three deaths, while renal failure, neurological dysfunction, and hematologic disorders each resulted in one fatality. Figure 2a presents the Kaplan-Meier analysis of the cohort. The estimated probability of long-term survival at five-year post-discharge was 74.8%, with most deaths occurring within the first 12 months after hospital discharge. Figure 2b presents the Kaplan-Meier survival analysis stratified by etiology with venous thrombosis having the most favorable etiology (p = 0.03).
Table 4.
Overall Post-Discharge survival of acute mesenteric ischemia patients stratified by etiology
| Etiology | Number of Patients | Discharged from Hospital, No. | Alive During Study Period, No. |
|---|---|---|---|
| Arterial Embolism | 19 | 9 (47.4%) | 6 (66.7%) |
| Arterial Thrombosis | 47 | 13 (27.7%) | 10 (76.9%) |
| Venous Thrombosis | 26 | 24 (92.3%) | 21 (87.5%) |
| Non-Occlusive Mesenteric Ischemia | 12 | 6 (50.0%) | 4 (66.7%) |
| Total | 104 | 52 (50.0%) | 41 (78.9%) |
Fig. 2.
a Kaplan Meier curve illustrating post-discharge survival in patients with acute mesenteric ischemia. Five-year survival: 74.8%. b Kaplan Meier curve illustrating post-discharge survival stratified by etiology. Survival differences were statistically significant (p=0.03). NOMI Non-Occlusive Mesenteric Ischemia
Discussion
In this retrospective cohort study spanning a 15-year period, we report both short- and long-term outcomes of patients undergoing surgery for AMI, with significant in-hospital mortality observed. The majority of post-discharge deaths occurred within the first year, after which survival rates plateaued. Disease etiology and comorbidity burden were identified as variables associated with in-hospital mortality. These findings align with previous research and are reflective of the clinical complexities involved in managing AMI [1, 4].
Non-survivors were, on average, a decade older, with a higher comorbidity burden compared to survivors, both of which are inherently non-modifiable factors at presentation. Similar associations were reported by Acosta-Merida et al. [6]. While specific comorbidities varied across the literature, the combined impact of advanced age and chronic disease remains a primary determinant of patient vulnerability [4, 6, 11–17].
Clinical presentation at admission offered limited discriminative value between survivors and non-survivors. Notably, only 6% of the cohort presented with MAP < 65 mmHg. This underscores the diagnostic challenges in AMI, where normotension could be misinterpreted as clinical stability or the absence of disease, and may contribute to delayed intervention and disease progression. The association between hypotension and mortality remains poorly characterized, with few studies reporting conflicting results [18–20].
Laboratory and imaging however offered better associations with patient outcomes than clinical presentation. In this study, elevated WBC count, higher creatinine values, and reduced hemoglobin levels were significantly associated with in-hospital mortality. Although lactate levels were higher in non-survivors, the difference was not statistically significant, potentially reflecting limitations in sample size. While these markers have been implicated in AMI prognosis, isolated initial laboratory values may be difficult to interpret, and serial measurements are likely more reliable predictors of mortality [4, 21, 22]. Furthermore, CT scan findings offered additional prognostic insights, with pneumatosis intestinalis and porto-mesenteric venous gas demonstrating associations with in-hospital mortality. Imaging-based associations were similarly reported by Sumbal et. al. [4].
Beyond clinical presentation and imaging, the underlying etiology plays a critical role in patient survival, and a significant correlation between arterial etiology and mortality is noted, with this accounting for 80% of in-hospital mortality. Previous studies have consistently demonstrated higher mortality rates in patients with arterial thrombosis and NOMI compared to those with venous thrombosis [5, 11]. The observed differences reflect underlying pathophysiology. Arterial etiology is associated with atherosclerosis and cardiac conditions prevalent in older age, and typically affect the SMA territory rapidly, whereas venous thrombosis results from hypercoagulable states across all ages and produces a more segmental and gradual pattern of bowel involvement [23, 24]. Moreover, this study demonstrated venous thrombosis resulted in more favorable long-term survival outcomes, signifying that following surgical intervention and anticoagulation, the underlying pathology is definitively addressed. Conversely, those with arterial forms of AMI continue to contend with systemic disease, which heightens overall vulnerability.
An important finding in this study was the correlation between extensive bowel resection and in-hospital mortality, serving as a proxy for ischemic burden. There is limited literature reporting on this association including a retrospective study by Akyıldız et al. that described bowel length exceeding 100 cm as a predictor of mortality [25, 26]. Alternatively, other studies examined the residual bowel length in relation to outcomes [27, 28]. In this study, the retrospective design, combined with the emergency context and time-critical need to expedite patients from the operating room limited the accurate intraoperative measurement of residual bowel. Nonetheless, none of the discharged patients required parenteral nutrition, suggesting the absence of short bowel syndrome, the adverse outcome most closely linked to insufficient residual length. Preservation of maximal normal bowel remains crucial for optimizing long-term outcomes [24].
The postoperative trajectory of this patient cohort provides valuable clinical observations. A substantial proportion of patients experienced adverse outcomes requiring intervention. Infectious, renal, and respiratory complications were among the most frequently observed. These sequalae reflect the systemic insult of the ischemic injury and the fragility of this patient population, findings consistent with prior reports, despite the inevitable variability in how studies define and capture postoperative complications [14, 22, 29].
A key finding of this study was the post-discharge survival outcomes of patients who successfully underwent surgical intervention for AMI and were subsequently discharged home. The estimated overall post-discharge survival probability was 74.8% at 5 years, with most deaths occurring during the first 12 months following discharge. These results show that hospital discharge is an important prognostic milestone and despite the high in-hospital mortality rate, patients who survive the index hospital admission have an appreciable probability of long-term survival. We also highlight the first year as a period of heightened risk. Rehabilitation and proactive management of comorbidities may improve long-term survival.
Although risk factors for mortality may not be modifiable at the time of presentation, these findings reinforce the importance of preventative measures and early-recognition strategies in high-risk groups. Targeted risk stratification, patient education regarding warning signs, proactive use of diagnostic imaging and maintaining a low threshold for surgical exploration in those with known arterial disease may enable earlier intervention and mitigate the progression of bowel infarction. Additionally, these findings equip healthcare providers with valuable insight to aid in patient counselling and setting expectations.
Limitations
Acknowledging the limitations intrinsic to a retrospective methodology is important when interpreting our results. Given the complexity of the diagnosis and the lack of a standardized approach to patient management, with varying thresholds of exploration and subsequent re-explorations largely dependent on surgeon experience and institutional norms, potentially resulting in selection bias and heterogeneity of practice. Furthermore, the single center nature of the study and the regional variations of access to ancillary services may restrict the generalizability of findings to institutions with different resources.
Conclusion
This retrospective cohort provides real-world survival data on patients with AMI, highlighting associations between in-hospital mortality and factors such as advanced age, associated comorbidity burden, arterial etiology, and extensive bowel resection. While surgical resection achieves source control, patient outcomes appear to reflect broader physiological vulnerability rather than surgical technique alone. Although in-hospital mortality remains considerable, discharged patients demonstrate reasonable long-term survival. Future research should focus on improving early detection to mitigate physiological decline.
Supplementary Information
Below is the link to the electronic supplementary material.
Author contributions
Author Contributions: All authors included provided substantial contributions to the conception and design of the work; material preparation and data acquisition was carried out by all authors; analysis and interpretation of data was performed by F.A. and J.A.; all authors contributed to drafting and reviewing of the manuscript critically and final approval of the version published. Study conception and design: F.A., H.A., H.S., N.A., M.S., B.A., J.A.Acquisition of data: F.A., H.A., H.S., N.A., M.S., B.A., J.A.Analysis and interpretation of data: F.A., J.A.Drafting of manuscript: F.A., H.A., H.S., N.A., M.S., B.A., J.A.Critical revision of manuscript: F.A., H.A., H.S., N.A., M.S., B.A., J.A.
Funding
This study did not receive any funding.
Data availability
The data generated and analyzed for the current study are not publicly available but may be obtained from the corresponding author upon reasonable request.
Declarations
Acknowledgements Statements and Declarations
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.
Ethics approval
The institutional ethical committee of the Ministry of Health approved this study, and the requirement for written consent was waived due to the retrospective design of this study.
Presentation
None.
Assistance with the study
None.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data generated and analyzed for the current study are not publicly available but may be obtained from the corresponding author upon reasonable request.