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Association of Perioperative Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia

Takuya Takami1, Kayoko Mizuno2, Kazutaka Obama3

  • 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

The Journal of Surgical Research
|September 25, 2025
PubMed
Abstract

Insights

Perioperative vasodilator therapy significantly reduces mortality in patients undergoing surgery for nonocclusive mesenteric ischemia (NOMI). This treatment may be a valuable addition to surgical management for NOMI, improving patient outcomes.

Area of Science:

  • Vascular Surgery
  • Gastrointestinal Surgery
  • Pharmacology

Background:

  • Nonocclusive mesenteric ischemia (NOMI) is a critical condition with high mortality due to mesenteric hypoperfusion.
  • Clinical guidelines suggest vasodilator therapy, but its efficacy in surgical NOMI is uncertain.
  • This study evaluates perioperative vasodilator use in surgically treated NOMI patients.

Purpose of the Study:

  • To assess the effectiveness of perioperative vasodilator therapy in patients undergoing surgery for NOMI.
  • To determine the impact of vasodilators on mortality and other key outcomes in this patient population.

Main Methods:

  • Retrospective cohort study using a Japanese nationwide real-world database (2014-2024).
  • Included patients undergoing surgery for NOMI, comparing vasodilator (prostaglandin E1 or papaverine hydrochloride) and nonvasodilator groups.
  • Utilized inverse probability of treatment weighting (IPTW) to control for baseline differences; primary outcome was 30-day mortality.

Main Results:

  • Analysis included 702 patients (86 vasodilator, 616 nonvasodilator).
  • IPTW balanced baseline characteristics.
  • The vasodilator group demonstrated significantly lower 30-day mortality (HR 0.44) and in-hospital mortality (RR 0.62).
  • No significant differences in reoperation or complication rates were observed.

Conclusions:

  • Perioperative vasodilator therapy is associated with reduced mortality in patients undergoing surgery for NOMI.
  • Findings support vasodilator therapy as a potentially beneficial adjunct in the surgical management of NOMI.
  • Further research may solidify the role of vasodilators in improving NOMI surgical outcomes.
Keywords:
MortalityNOMINon-occlusive mesenteric ischemiaPapaverine hydrochloridePerioperativeProstaglandin E1Surgical caseVasodilator therapy

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