TREATMENT STRATEGY AND INTERVENTION TIMING IN ELDERLY PATIENTS WITH ACUTE MESENTERIC ISCHEMIA: A MULTICENTER RETROSPECTIVE COHORT STUDY

Vollständiger Abstract

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Introduction: This study aimed to evaluate the association between treatment modality, intervention timing, and clinical outcomes in patients aged 65 years or older with acute mesenteric ischemia (AMI). Methods: This multicenter retrospective cohort study included 126 patients aged 65 years or older who were diagnosed with AMI between January 2015 and December 2025. Patients were classified according to treatment modality as endovascular treatment, open surgery, or conservative management. The primary outcome was 30-day mortality. Secondary outcomes included in-hospital mortality, intensive care unit admission, length of hospital stay, complications, and reoperation. Propensity score–based inverse probability of treatment weighting (IPTW) and multivariable logistic regression analyses were performed to reduce potential confounding. Results: The 30-day mortality rate was lower in the endovascular treatment group (26.2%) than in the open surgery (45.5%) and conservative management (45.0%) groups (p=0.041). Delayed intervention (>12 hours) was associated with an increased risk of mortality (OR: 2.68; 95% CI: 1.18–6.09; p=0.018). Serum lactate level, age, and Charlson Comorbidity Index were identified as independent predictors of 30-day mortality. In the IPTW-adjusted analysis, open surgery was associated with higher mortality compared with endovascular treatment (OR: 1.94; 95% CI: 1.05–3.58; p=0.034). Conclusion: Treatment modality and timing of intervention appear to be associated with clinical outcomes in elderly patients with AMI. Endovascular treatment was associated with lower 30-day mortality, whereas delayed intervention was linked to poorer outcomes. However, these findings should be interpreted cautiously because of the retrospective study design and the possibility of residual confounding.