The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality

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dc.contributor.author Tolonen, Matti
dc.contributor.author Lemma, Aurora
dc.contributor.author Vikatmaa, Pirkka
dc.contributor.author Peltola, Erno
dc.contributor.author Mentula, Panu
dc.contributor.author Björkman, Patrick
dc.contributor.author Leppäniemi, Ari
dc.contributor.author Sallinen, Ville
dc.date.accessioned 2021-10-19T09:20:03Z
dc.date.available 2021-10-19T09:20:03Z
dc.date.issued 2021-09
dc.identifier.citation Tolonen , M , Lemma , A , Vikatmaa , P , Peltola , E , Mentula , P , Björkman , P , Leppäniemi , A & Sallinen , V 2021 , ' The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality ' , Journal of trauma and acute care surgery , vol. 91 , no. 3 , pp. 480-488 . https://doi.org/10.1097/TA.0000000000003305
dc.identifier.other PURE: 169605591
dc.identifier.other PURE UUID: 6b54fbe4-2ab3-4ee8-a7c8-7dc97b5f709b
dc.identifier.other WOS: 000693463000013
dc.identifier.uri http://hdl.handle.net/10138/335445
dc.description.abstract BACKGROUND Acute mesenteric ischemia (AMI) is a disease with high mortality and requires a multidisciplinary approach for effective management. A pathway and care bundle were developed and implemented with the objective to reduce mortality. The aim of this retrospective comparative study was to analyze the effects of the pathway on patient management and outcome. METHODS All consecutive patients operated in a secondary and tertiary referral center because of occlusive arterial AMI were identified between 2014 and April 2020. The pathway aimed to increase overall awareness, and hasten and improve diagnostics and management. Patients treated before implementation of the pathway (pregroup, years 2014-2017) were compared with patients treated using the pathway (postgroup, May 2018 to April 2020). Univariate and multivariate analyses were used to compare the groups. RESULTS There were 78 patients in the pregroup and 67 patients in the postgroup with comparable baseline characteristics and disease acuity. The postgroup was more often diagnosed with contrast-enhanced computed tomography (58 [74%] vs. 63 [94%], p = 0.001) and had shorter mean in-hospital delay to operating room (7 hours [interquartile range, 3.5-12.5] vs. 3 hours [interquartile range, 2-11], p = 0.023). Revascularization was done more often in the postgroup (53 [68%] vs. 56 [84%], p = 0.030) especially using endovascular treatment (26 [33%] vs. 43 [64%], p < 0.001). Thirty-day mortality was lower in the postgroup (23 [51%] vs. 17 [25%], p = 0.001). Being managed in the postgroup remained as a protective factor (odds ratio, 0.32; 95% confidence interval, 0.14-0.75; p = 0.008) for 30-day mortality in the multivariate analysis. CONCLUSION Implementing a pathway and care bundle resulted in enhanced regional and in-hospital awareness of AMI, more appropriate computed tomography imaging, shorter in-hospital delays, increased number of revascularizations, and, hence, lower mortality. en
dc.format.extent 9
dc.language.iso eng
dc.relation.ispartof Journal of trauma and acute care surgery
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject Revascularization
dc.subject endovascular
dc.subject open abdomen
dc.subject ACUTE ABDOMEN
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.title The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality en
dc.type Article
dc.contributor.organization HUS Abdominal Center
dc.contributor.organization Verisuonikirurgian yksikkö
dc.contributor.organization HUS Medical Imaging Center
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.contributor.organization II kirurgian klinikka
dc.contributor.organization Staff Services
dc.contributor.organization Clinicum
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/10.1097/TA.0000000000003305
dc.relation.issn 2163-0755
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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