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Mortality Prediction Model before Surgery for Acute Mesenteric Infarction: A Population-Based Study
Shang-Wei Lin1,2,3, Chung-Yen Chen1,3,4,5, Yu-Chieh Su3,6
1Department of Surgery, E-Da Hospital, Kaohsiung 82445, Taiwan.
Abstract:
Surgery for acute mesenteric infarction (AMI) is associated with high mortality. This study aimed to generate a mortality prediction model to predict the 30-day mortality of surgery for AMI. We included patients ≥18 years who received bowel resection in treating AMI and randomly divided into the derivation and validation groups. After multivariable analysis, the ‘Surgery for acute mesenteric infarction mortality score’ (SAMIMS) system was generated and was including age >62-year-old (3 points), hemodialysis (2 points), congestive heart failure (1 point), peptic ulcer disease (1 point), diabetes (1 point), cerebrovascular disease (1 point), and severe liver disease (4 points). The 30-day-mortality rates in the derivation group were 4.4%, 13.4%, 24.5%, and 32.5% among very low (0 point), low (1−3 point(s)), intermediate (4−6 points), and high (7−13 points)-risk patients. Compared to the very-low-risk group, the low-risk (OR = 3.332), intermediate-risk (OR = 7.004), and high-risk groups (OR = 10.410, p < 0.001) exhibited higher odds of 30-day mortality. We identified similar results in the validation group. The areas under the ROC curve were 0.677 and 0.696 in the derivation and validation groups. Our prediction model, SAMIMS, allowed for the stratification of the patients’ 30-day-mortality risk of surgery for acute mesenteric infarction.
Insights
A new scoring system, SAMIMS, predicts 30-day mortality for surgery in acute mesenteric infarction (AMI) patients. This tool stratifies risk, aiding clinical decision-making for AMI surgical outcomes.
Area of Science:
- Surgical outcomes research
- Clinical prediction modeling
- Gastrointestinal surgery
Background:
- Surgery for acute mesenteric infarction (AMI) carries a high mortality rate.
- Effective risk stratification is crucial for managing AMI patients undergoing surgery.
Purpose of the Study:
- To develop and validate a predictive model for 30-day mortality in patients undergoing surgery for AMI.
- To create the ‘Surgery for acute mesenteric infarction mortality score’ (SAMIMS) system.
Main Methods:
- Multivariable analysis was used to identify predictors of 30-day mortality.
- Patients undergoing bowel resection for AMI were divided into derivation and validation groups.
- The SAMIMS system incorporates factors such as age, hemodialysis, heart failure, peptic ulcer disease, diabetes, cerebrovascular disease, and liver disease.
Main Results:
- The SAMIMS score effectively stratified patients into very low, low, intermediate, and high-risk groups for 30-day mortality.
- Mortality rates increased significantly with higher risk scores in both derivation and validation cohorts.
- The model demonstrated good discriminative ability with areas under the ROC curve of 0.677 and 0.696.
Conclusions:
- The developed SAMIMS prediction model enables accurate stratification of 30-day mortality risk in surgical patients with AMI.
- This tool can assist clinicians in identifying high-risk individuals and tailoring perioperative management.
- The SAMIMS system offers a valuable approach to improving outcomes for acute mesenteric infarction surgery.
