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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dc.contributor.author Lemma, Aurora N.
dc.contributor.author Tolonen, Matti
dc.contributor.author Vikatmaa, Pirkka
dc.contributor.author Mentula, Panu
dc.contributor.author Vikatmaa, Leena
dc.contributor.author Kantonen, Ilkka
dc.contributor.author Leppäniemi, Ari
dc.contributor.author Sallinen, Ville
dc.date.accessioned 2019-11-26T11:42:01Z
dc.date.available 2019-11-26T11:42:01Z
dc.date.issued 2019-06
dc.identifier.citation 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
dc.identifier.other PURE: 128400410
dc.identifier.other PURE UUID: 54e6dfb2-a57e-4cc1-94a6-eafd7f2d880a
dc.identifier.other RIS: urn:9384C4270D56751F8E195D4CEFBA17FE
dc.identifier.other WOS: 000471825900021
dc.identifier.uri http://hdl.handle.net/10138/307455
dc.description.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. en
dc.format.extent 8
dc.language.iso eng
dc.relation.ispartof European Journal of Vascular and Endovascular Surgery
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.subject DELAY
dc.subject Embolus
dc.subject Emergency
dc.subject Revascularisation
dc.subject THROMBOSIS
dc.title Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage en
dc.type Article
dc.contributor.organization HUS Abdominal Center
dc.contributor.organization Department of Surgery
dc.contributor.organization II kirurgian klinikka
dc.contributor.organization Doctoral Programme in Clinical Research
dc.contributor.organization Verisuonikirurgian yksikkö
dc.contributor.organization University of Helsinki
dc.contributor.organization Staff Services
dc.contributor.organization HUS Perioperative, Intensive Care and Pain Medicine
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.contributor.organization Anestesiologian yksikkö
dc.contributor.organization Pertti Panula / Principal Investigator
dc.contributor.organization Department of Anatomy
dc.contributor.organization IV kirurgian klinikka
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1016/j.ejvs.2019.01.002
dc.relation.issn 1078-5884
dc.rights.accesslevel openAccess
dc.type.version publishedVersion
dc.type.version draft

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