Acute mesenteric ischemia in older adults: clinical profiles, management patterns, and outcomes in medical and surgical settings.

AIM: To evaluate the clinical profile, management, and outcomes of patients hospitalized with acute mesenteric ischemia (AMI). Secondary objectives were to identify factors associated with surgical intervention and in-hospital mortality in this patient population.

METHODS

We conducted a retrospective multicenter study including 693 adult patients diagnosed with AMI across 10 hospitals in Southern Spain between 2010 and 2020. Data collected included demographics, comorbidities, functional status, treatment strategies, and outcomes.

RESULTS

A total of 693 patients were studied, 360 (54.2%) were women. The median age was 77.8 years; 85.8% were aged ≥ 65 years, and 31.8% were ≥ 85 years. In-hospital mortality was 62.4%, increasing to 70.1% among the very old people. A total of 62.6% of patients were admitted to Internal Medicine departments; these patients were older, more functionally dependent (57.8%), and more likely to have dementia (24.9%) than those admitted elsewhere. Only 18.5% underwent surgery. Baseline functional (OR 4.54; 95% CI 1.45-14.22; p = 0.009) and male sex (OR 2.64; 95% CI 1.12-6.22; p = 0.027). were the strongest predictor of surgical intervention. Older age was the strongest independence variabile related to mortality (OR 1.70; 95% CI 1.09-2.64; p = 0.020).

CONCLUSIONS

AMI is a severe abdominal emergency that primarily affects older adults. Its nonspecific presentation often delays diagnosis, contributing to high mortality. Early detection and multidisciplinary management, involving internists and geriatricians, are key to improving prognosis and guiding treatment decisions aligned with patients' overall goals and functional status.