Title : Acute mesenteric ischaemia: A current australian perspective
Abstract:
Introduction: Acute Mesenteric Ischaemia (AMI) is a surgical emergency, requiring multidisciplinary collaboration. Prompt diagnosis and treatment is vital yet frequently delayed. Research internationally has considered this and begun to implement clinical guidelines to improve outcomes. This has yet to be considered in an Australian setting, and as such this study aimed to address this though assessing current diagnosis and management within a tertiary hospital from 2020 to 2025.
Methods: A retrospective audit was completed of patients admitted to the Royal Melbourne Hospital general surgical unit with a diagnosis of AMI over the last five years. Demographic data, management information and mortality outcomes were recorded.
Results: 32 patients were managed with a diagnosis of AMI over the five years, with an average of 5.3 patients each year and a median age of 72.5 years (IQR 15.5). 25.8% of patients were transfers, most commonly from regional or rural centres. 62.5% of the patients were male, with the most common recorded comorbidities being hypercholesterolaemia (43.8%) and current smoking status (41.9%). At time of diagnosis, almost all patients had abdominal pain (91.3%) and most demonstrated a metabolic disturbance (lactatemia (77.8%), acidotic (63.0%). 93.7% of patients underwent operative management with vascular surgical involvement in 61.3% of cases. 96.9% required ICU admission, with a median total length of stay of 14 days (IQR 27.8). Mortality was 46.9%.
Conclusion: AMI is a rare, but often fatal diagnosis. International research suggests guidelines improve outcomes and reduces mortality, and this should begin to be considered in an Australian context. This study demonstrates important factors that should be considered in guideline development, which is currently in development stages.
