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European Journal of Trauma and Emergency Surgery

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25-05-2023 | Visceral Ischemia | Original Article

Factors associated with the need for long-term total parenteral nutrition in survivors of acute superior mesenteric artery occlusion

Authors: Yuki Nakao, Hideki Sasanuma, Naohiro Sata, Nobumi Tagaya, Kenji Matsumoto, Taiki Mizobuchi, Fumiki Koga, Errington Thompson, Alan Lefor

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2023

Abstract

Background

Acute superior mesenteric artery (SMA) occlusion is an uncommon condition associated with high mortality. If extensive bowel resection is performed for patients with acute SMA occlusion and the patient survives, long-term total parenteral nutrition (TPN) may be needed due to short bowel syndrome. This study examined factors associated with the need for long-term TPN after the treatment of acute SMA occlusion.

Methods

We retrospectively analyzed 78 patients with acute SMA occlusion. Patients were abstracted from a Japanese database from institutions with at least 10 patients with acute SMA occlusive disease from January 2015 through December 2020

Results

Among the initial cohort there were 41/78 survivors. Of these, 14/41 (34%) required permanent TPN who were compared with those who did not require long-term TPN (27/41, 66%). Compared to patients in the non-TPN group, those in the TPN group had significantly shorter remaining small intestine (90.7 cm vs. 218 cm, P<0.01), more patients with time from onset to intervention >6 hours (P=0.02), pneumatosis intestinalis on enhanced computed tomography scan (P=0.04), ascites (Odds Ratio 11.6, P<0.01), and a positive smaller superior mesenteric vein sign (P= 0.03). These were considered significant risk factors for needing long-term TPN. Age, gender, underlying disease, presence of peritoneal sign, presence of shock requiring vasopressors, site of obstruction (proximal vs. distal), and initial treatment (surgery vs. interventional radiology vs. thrombolytic therapy) were not significantly different between the two groups. Long-term TPN was significantly associated with longer hospital stay (52 vs. 35 days, P=0.04). Multivariate analysis identified the presence of ascites as an independent risk factor for needing long-term TPN.

Conclusion

The need for permanent TPN after treatment of acute SMA occlusion is significantly associated with longer hospital stay, longer time to intervention, and characteristic imaging findings (pneumatosis intestinalis, ascites, Smaller SMV sign). Ascites is an independent risk factor.

Level of evidence

III.

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Title: Factors associated with the need for long-term total parenteral nutrition in survivors of acute superior mesenteric artery occlusion
Authors: Yuki Nakao
Hideki Sasanuma
Naohiro Sata
Nobumi Tagaya
Kenji Matsumoto
Taiki Mizobuchi
Fumiki Koga
Errington Thompson
Alan Lefor
Publication date: 25-05-2023
Publisher: Springer Berlin Heidelberg
Keywords: Visceral Ischemia
Computed Tomography
Computed Tomography
Interventional Radiology
Nutrition
Ascites
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-023-02281-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors associated with the need for long-term total parenteral nutrition in survivors of acute superior mesenteric artery occlusion

Abstract

Background

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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