The Risk of Mortality in Elderly Patients with Acute Vascular Insufficiency of the Intestine is 2.5-Fold Greater than that in Adult Patients: An Analysis of 36,864 Patients.

Abstract

Introduction: Vascular insufficiency of the intestine is difficult to diagnose and it has high mortality rates. Our study aimed to identify risk factors for in-hospital mortality of patients emergently admitted with the primary diagnosis of vascular insufficiency of the intestine.

Materials and methods: Adult (18-64 years) and elderly (>64 years) patients emergently admitted with the primary diagnosis of vascular insufficiency of the small and large intestine were analyzed using the National Inpatient Sample database from 2005-2014. Using stratified analysis and backward multivariable logistic regression analysis, the relationship between mortality and several risk factors were evaluated.

Results: There were 36,864 patients analyzed of which 4,994 died in hospital. Most patients were elderly, making up 23,052 of the total patients (63.4%). The mean (SD) age for adult males, adult females, elderly males, and elderly females were 50.51 (11.18), 52.12 (10.06), 77.00 (7.50), and 78.44 (7.88) years, respectively. When the data was stratified according to outcome, deceased adult patients accounted for 6.9% of all adult patients, while elderly deceased patients accounted for 17.5% of all elderly patients. Elderly patients had a 2.5 times increase in mortality compared to adult patients. When the data was stratified according to operation status, non-operation patients had 58.6% use of gastrointestinal invasive diagnostic procedures, as opposed to the operative patients with 30.3% use. In the final regression model, age (OR=1.03, 95%CI: 1.02-1.04), male sex (OR=1.12, 95%CI: 1.04-1.21), operation (OR=2.73, 95%CI: 2.50-2.97), bacterial infections (OR=3.12, 95%CI: 2.82-3.44), respiratory diseases, (OR=1.84, 95%CI: 1.71-1.99), cardiac diseases (OR=2.78, 95%CI: 2.09-2.48), liver diseases (OR=2.24, 95%CI: 1.99-2.53), genitourinary system diseases (OR=1.40, 95%CI: 1.30-1.51), fluid and electrolyte disorders (OR=1.48, 95%CI: 1.37-1.60), neurological diseases (OR=1.23, 95%CI: 1.13-1.33), and trauma, burns, and poisons (OR=1.57, 95%CI: 1.43-1.73) were the risk factors for mortality. Gastrointestinal invasive diagnostic procedures (OR=0.31, 95%CI: 0.28-0.34) and hospital length of stay (OR=0.91, 95%CI: 0.90-0.92) were protective factors for mortality in all patients.

Conclusion: For elderly patients emergently admitted for intestinal vascular insufficiency, the odds of mortality were 2.5 times greater than in adult patients. Age, male sex, operation, and several comorbidities were risk factors for mortality; whereas, invasive diagnostic procedures and longer hospital stay were the protective factors against mortality.