PMID- 29395425
OWN - NLM
STAT- MEDLINE
DCOM- 20180716
LR  - 20180716
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 67
IP  - 6
DP  - 2018 Jun
TI  - Improved mortality in treatment of patients with endovascular interventions for 
      chronic mesenteric ischemia.
PG  - 1805-1812
LID - S0741-5214(17)32652-6 [pii]
LID - 10.1016/j.jvs.2017.10.071 [doi]
AB  - OBJECTIVE: Chronic mesenteric ischemia (CMI) continues to be a devastating 
      diagnosis. There is a national trend toward increased use of endovascular 
      procedures with improved survival for the treatment of these patients. Our aim 
      was to evaluate whether this trend has changed CMI patients' length of 
      hospitalization and health care cost. METHODS: We identified all patients 
      admitted for CMI from the National Inpatient Sample (NIS) from 2000 to 2014. Our 
      primary end points included length of hospital stay (LOS) and cost of 
      hospitalization (COH). Our secondary end points included mortality assessment of 
      the CMI hospitalization. RESULTS: There were 15,475 patients admitted for CMI. 
      The mean age of patients was 71 years, and 4022 (26.0%) were male. There were 
      10,920 (70.6%) patients treated endovascularly (ENDO) and 4555 (29.4%) patients 
      treated in an open fashion (OPEN). Although a higher proportion of patients in 
      the ENDO (43.3%) group vs OPEN (33.1%) had a Charlson Comorbidity Index score of 
      >/=2 (P < .0001), they had a lower mortality rate (2.4% vs 8.7%; P < .0001), lower 
      mean LOS (6.3 vs 14.0 days; P < .0001), and lower COH ($21,686 vs $42,974; P < 
      .0001). After adjusting for clinical and hospital factors, OPEN continued to 
      demonstrate higher mortality than ENDO (odds ratio, 7.2; 95% confidence interval, 
      4.9-10.6; P < .0001), longer LOS (mean, +9.7 days; P < .0001), and higher COH 
      (mean, +$25,834; P < .0001). CONCLUSIONS: The rate of ENDO continues to rise 
      nationally in the treatment of CMI patients. After adjusting for clinical and 
      hospital factors, patients in the ENDO group tend to have lower in-hospital 
      mortality of 2.4% and lower LOS by 10 days, and they incur a cost saving of 
      >$25,000 compared with patients in the OPEN group. ENDO should be considered 
      first line of therapy for patients with CMI.
CI  - Copyright (c) 2017 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Erben, Young
AU  - Erben Y
AD  - Section of Vascular and Endovascular Surgery, Department of Surgery, Yale School 
      of Medicine, New Haven, Conn. Electronic address: young.erben@yale.edu.
FAU - Jean, Raymond A
AU  - Jean RA
AD  - Department of Surgery, Yale School of Medicine, New Haven, Conn; National 
      Clinician Scholars Program, Department of Internal Medicine, Yale School of 
      Medicine, New Haven, Conn.
FAU - Protack, Clinton D
AU  - Protack CD
AD  - Department of Surgery, Yale School of Medicine, New Haven, Conn.
FAU - Chiu, Alex S
AU  - Chiu AS
AD  - Department of Surgery, Yale School of Medicine, New Haven, Conn.
FAU - Liu, Shirley
AU  - Liu S
AD  - Department of Surgery, Yale School of Medicine, New Haven, Conn.
FAU - Sumpio, Brandon J
AU  - Sumpio BJ
AD  - Department of Surgery, Yale School of Medicine, New Haven, Conn.
FAU - Miller, Samuel M
AU  - Miller SM
AD  - Warren Alpert Medical School, Brown University, Providence, RI.
FAU - Sumpio, Bauer E
AU  - Sumpio BE
AD  - Section of Vascular and Endovascular Surgery, Department of Surgery, Yale School 
      of Medicine, New Haven, Conn.
LA  - eng
GR  - TL1 TR001864/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
DEP - 20180212
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Chronic Disease
MH  - *Endovascular Procedures
MH  - Female
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Male
MH  - Mesenteric Ischemia/*mortality/surgery
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Risk Factors
MH  - *Stents
MH  - Survival Rate/trends
MH  - Time Factors
MH  - United States/epidemiology
MH  - Young Adult
EDAT- 2018/02/06 06:00
MHDA- 2018/07/17 06:00
CRDT- 2018/02/04 06:00
PHST- 2017/07/27 00:00 [received]
PHST- 2017/10/03 00:00 [accepted]
PHST- 2018/02/06 06:00 [pubmed]
PHST- 2018/07/17 06:00 [medline]
PHST- 2018/02/04 06:00 [entrez]
AID - S0741-5214(17)32652-6 [pii]
AID - 10.1016/j.jvs.2017.10.071 [doi]
PST - ppublish
SO  - J Vasc Surg. 2018 Jun;67(6):1805-1812. doi: 10.1016/j.jvs.2017.10.071. Epub 2018 
      Feb 12.