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Review
. 2020 Oct 5:2020:1382475.
doi: 10.1155/2020/1382475. eCollection 2020.

Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis

Wenhan Wu  1 , Jianbo Liu  1 , Zongguang Zhou  1
Affiliations
Review

Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis

Wenhan Wu et al. Emerg Med Int. .

Abstract

Objective: Our objective was to comprehensively present the evidence of preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy.

Methods: PubMed, Embase, and Google Scholar were searched from January 2000 to January 2020. Studies evaluating the postoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy were included. The outcome extracted were patients' demographics, medical history, and preoperative laboratory tests.

Results: Twenty studies (5011 patients) met the inclusion criteria. Studies were of high quality, with a median Newcastle-Ottawa Scale Score of 7. Summary short-term postoperative mortality was 44.38% (range, 18.80%-67.80%). Across included studies, 49 potential risk factors were examined, at least two studies. Meta-analysis of predictors based on more than three studies identified the following preoperative risk factors for higher short-term postoperative mortality risk: old age (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.57-2.30), arterial occlusive mesenteric ischemia versus mesenteric venous thrombosis (OR, 2.45, 95% CI 1.12-5.33), heart failure (OR 1.33, 95% CI 1.03-1.72), renal disorders (OR 1.61, 95% CI 1.24-2.07), and peripheral vascular disease (OR 1.38, 95% CI 1.00-1.91). Nonsurvivors were older (standardized mean difference [SMD], 0.32, 95% CI 0.24-0.40), had higher creatinine levels (SMD 0.50, 95% CI 0.25-0.75), and had lower platelet counts (SMD -0.32, 95% CI -0.50 to -0.14).

Conclusion: The short-term postoperative mortality of acute mesenteric ischemia who underwent laparotomy is still high. A better understanding of these risk factors may help in the early identification of high-risk patients, optimization of surgical procedure, and improvement of perioperative management.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plots for significant preoperative risk factors for short-term postoperative mortality of AMI after laparotomy with data available in at least four studies (demographics and etiology). AOMI: arterial occlusive mesenteric ischemia; FE: fixed effect; MVT: mesenteric venous thrombosis; RE: random effect. (a) Old age (categorical variable), (b) age (continuous variable), and (c) AOMI versus MVT (categorical variable).
Figure 3
Figure 3
Forest plots for significant preoperative risk factors for short-term postoperative mortality of AMI after laparotomy with data available in at least four studies (comorbidities). Notes: renal disorders include renal failure and chronic renal disease. FE: fixed effect; RE: random effect. (a) Heart failure (categorical variable), (b) renal disorders (categorical variable), and (c) peripheral vascular disease (categorical variable).
Figure 4
Figure 4
Forest plots for significant preoperative risk factors for short-term postoperative mortality of AMI after laparotomy with data available in at least four studies (laboratory tests). FE: fixed effect; RE: random effect. (a) Creatinine (continuous variable) and (b) platelet (continuous variable).
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