Autor:innen:
PD Dr. Andreas Kühnl | Klinikum rechts der Isar der Technischen Universität München | Germany
Tim Eger | Klinikum rechts der Isar der Technischen Universität München | Germany
Michael Salvermoser | Klinikum rechts der Isar der Technischen Universität München | Germany
PD Dr. med. habil. Matthias Trenner | Klinikum rechts der Isar der Technischen Universität München | Germany
Dr. Benedikt Reutersberg | Klinikum rechts der Isar der Technischen Universität München | Germany
Prof. Dr. Dr. med. Albert Busch | Klinikum rechts der Isar der Technischen Universität München | Germany
Prof. Dr. med. Hans-Henning Eckstein | Klinikum rechts der Isar der Technischen Universität München | Germany
Introduction: For Germany, reports on epidemiology, treatment, and outcome of acute mesenteric infarction (AMI) are almost solely based on single-centre studies or reviews of small cohorts. Additionally, risk factors associated with in-hospital mortality have not been investigated in unselected nationwide cohorts. Therefore, using a statutory database of all patients treated in German Hospitals between 2005 and 2014, hospital-incidence, treatment modality, in-hospital mortality, and risk factors were analysed.
Methods: This study is based on hospital episode data from 2005 to 2014. All cases with principal or secondary diagnosis of an AMI (K55.0) were included. Patient cohorts were grouped depending on whether they received visceral revascularization. Afterwards, revascularization procedures were subdivided into open-surgical or hybrid approach, and endovascular only procedures. Patients without vascular procedures were subdivided depending on whether bowel was resected or not. Outcome variables were hospital incidence per 100.000 inhabitants, type of treatment, and in-hospital mortality. In addition, a multivariable regression model was applied to identify factors that are associated with the probability of revascularization, endovascular treatment, and in-hospital mortality.
Results: In total, 218,580 patients with AMI were included of which 88,906 (41%) were male. In each group, the median age of women was higher compared to men. Among all cases, 9034 (4.1%) receive a revascularization procedure, and 79,203 (36.2%) received bowel resection only. Of these revascularizations, 6991 (77%) got an open surgical procedure and 2041 (23%) an endovascular treatment. Among patients undergoing revascularization, the proportion of patients receiving endovascular treatment rose from 10.9% to 32.5%. The overall age-, and sex standardized hospital incidence of AMI increased from 24.4 in 2005 to 26.2 per 100 000 inhabitants in 2014. The incidence of revascularization procedures raised from 0.76 to 1.23 per 100 000 inhabitants. Furthermore, standardised incidence of endovascular procedures increased from 0.08 to 0.41 per 100 000 inhabitants. Overall in-hospital mortality rate was 38.6% (open surgical 62.2%; endovascular 31.5%; bowel resection only 36.1%; other procedures 38.9%). The age-, sex-, and risk-adjusted mortality of the open surgery was reduced from 71% to 62%. Mortality of the endovascular treatment remained stable around 30%. Results of risk-factor and regression analyses will be presented.
Conclusion: For Germany, this is the first nationwide analysis of hospital incidence and mortality of AMI using a statutory database. Main findings are a higher hospital incidence of AMI compared to published studies, and a higher in-hospital mortality after open surgical revascularization than after endovascular revascularization. Moreover, the proportion of endovascular treatment has increased from 11% to 33%. Overall mortality decreased from 45% to 34%.