Endovascular Versus Surgical Revascularization for Chronic Mesenteric Ischemia: Insights From the National Inpatient Sample Database

JACC Cardiovasc Interv. 2017 Dec 11;10(23):2440-2447. doi: 10.1016/j.jcin.2017.09.033.

Abstract

Objectives: This study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI).

Background: There are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States.

Methods: Patients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample. Weighted national estimates were obtained. Primary and secondary endpoints were MACCE (death, myocardial infarction, stroke, cardiac post-operative complications) and composite in-hospital complications (MACCE + post-operative peripheral vascular complications, gastrointestinal hemorrhage, major bleeding, and bowel resection), respectively. Propensity score matching was used to obtain a balanced cohort of 880 unweighted patients in each group.

Results: Of 4,150 patients with CMI, 3,206 (77.2%) underwent endovascular therapy and 944 (22.8%) underwent surgery (weighted national estimates of 15,850 and 4,687, respectively). In the propensity-matched cohort, MACCE and composite in-hospital complications occurred significantly less often after endovascular therapy than surgery (8.6% vs. 15.9%; p < 0.001; and 15.3% vs. 20.3%; p < 0.006). Endovascular therapy was also associated with lower median hospital costs ($20,807.00 [interquartile range: $13,640.20 to $32.754.50] vs. $31,137.00 [interquartile range: $21,680.40 to $52,152.20]; p < 0.001, respectively) and shorter length of stay (5 [interquartile range: 2 to 10] vs. 10 [interquartile range: 7 to 17] days, respectively; p < 0.001) compared with open surgery.

Conclusions: In a large, retrospective analysis of patients with CMI, endovascular therapy remained the dominant revascularization modality, and was associated with lower rates of MACCE, composite in-hospital complications, lower costs, and shorter length of stay compared with surgery.

Keywords: Nationwide Inpatient Sample; chronic mesenteric ischemia; endovascular; in-hospital outcomes; open surgery; peripheral intervention.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Chronic Disease
  • Cost Savings
  • Cost-Benefit Analysis
  • Databases, Factual
  • Endarterectomy* / adverse effects
  • Endarterectomy* / economics
  • Endarterectomy* / mortality
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / economics
  • Endovascular Procedures* / mortality
  • Female
  • Hospital Costs
  • Humans
  • Inpatients
  • Length of Stay
  • Logistic Models
  • Male
  • Mesenteric Ischemia / diagnostic imaging
  • Mesenteric Ischemia / economics
  • Mesenteric Ischemia / mortality
  • Mesenteric Ischemia / therapy*
  • Mesenteric Vascular Occlusion / diagnostic imaging
  • Mesenteric Vascular Occlusion / economics
  • Mesenteric Vascular Occlusion / mortality
  • Mesenteric Vascular Occlusion / therapy*
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Propensity Score
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States
  • Vascular Grafting* / adverse effects
  • Vascular Grafting* / economics
  • Vascular Grafting* / mortality