Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage

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Lemma , A N , Tolonen , M , Vikatmaa , P , Mentula , P , Vikatmaa , L , Kantonen , I , Leppäniemi , A & Sallinen , V 2019 , ' Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage ' , European Journal of Vascular and Endovascular Surgery , vol. 57 , no. 6 , pp. 842-849 . https://doi.org/10.1016/j.ejvs.2019.01.002

Title: Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage
Author: Lemma, Aurora N.; Tolonen, Matti; Vikatmaa, Pirkka; Mentula, Panu; Vikatmaa, Leena; Kantonen, Ilkka; Leppäniemi, Ari; Sallinen, Ville
Contributor: University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
University of Helsinki, Staff Services
University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
University of Helsinki, Staff Services
Date: 2019-06
Language: eng
Number of pages: 8
Belongs to series: European Journal of Vascular and Endovascular Surgery
ISSN: 1078-5884
URI: http://hdl.handle.net/10138/307455
Abstract: Objectives: Despite modern advances in diagnosis and treatment, acute arterial mesenteric ischaemia (AMI) remains a high mortality disease. One of the key modifiable factors in AMI is the first door to operation time, but the factors attributing to this parameter are largely unknown. The aim of this study was to evaluate the factors affecting delay, with special focus on the pathways to treatment. Methods: This was a single academic centre retrospective study. Patients undergoing intervention for AMI caused by thrombosis or embolism of the superior mesenteric artery between 2006 and 2015 were identified from electronic patient records. Patients not eligible for intervention or with chronic, subacute onset, colonic only, venous, or non-occlusive mesenteric ischaemia were excluded. Patients were divided into two groups according to the first speciality examining the patient (surgical emergency room [SER], surgeon examining the patient first or non-surgical emergency room [non-SER], internist examining the patient first). The primary endpoint was first door to operation time and secondary endpoints were length of stay and 90 day mortality. Results: Eighty-one patients with AMI were included. Fifty patients (62%) died during the first 30 days and 53 (65%) within 90 days. Presenting first in non-SER (vs. SER) was independently associated with a first door to operation time of over 12 h (OR 3.7 [95% CI 1.3-10.2], median time 15.2 h [IQR 10.9-21.2] vs. 10.1 h [IQR 6.9-18.5], respectively, p = .025). The length of stay was shorter (median 6.5 days [4.0-10.3] vs. 10.8 days [7.0-22.3], p = .045) and 90 day mortality was lower in the SER group (50.0% vs. 74.5%, p = .025). Conclusions: The first specialty that the patient encounters seems to be crucial for both delayed management and early survival of AMI. Developing fast/direct pathways to a unit with both gastrointestinal and vascular surgeons offers the possibility of improving the outcome of AMI.
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
DELAY
Embolus
Emergency
Revascularisation
THROMBOSIS
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