Association of Perioperative Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia.

INTRODUCTION

Nonocclusive mesenteric ischemia (NOMI) is a life-threatening condition characterized by mesenteric hypoperfusion without arterial occlusion and is associated with a high mortality rate. Although vasodilator therapy is recommended in clinical guidelines, its effectiveness in surgical cases of NOMI remains unclear. In this study, we aimed to evaluate the effectiveness of perioperative vasodilator therapy in patients undergoing surgery for NOMI, using a nationwide real-world database in Japan.

METHODS

A retrospective cohort study was conducted using data from 2014 to 2024. Patients who underwent surgery for NOMI were included and categorized into a vasodilator group (those who received prostaglandin E1 or papaverine hydrochloride within 1 d before or after surgery) and a nonvasodilator group. Inverse probability of treatment weighting with stabilized weights was applied to adjust for baseline differences. The primary outcome was 30-d mortality. Secondary outcomes included in-hospital mortality, reoperation proportion, and complication proportion.

RESULTS

A total of 702 patients were analyzed (86 in the vasodilator group and 616 in the nonvasodilator group). After inverse probability of treatment weighting, baseline characteristics were well balanced. The vasodilator group showed significantly lower 30-d mortality (weighted hazard ratio, 0.44; 95% confidence interval (CI), 0.22-0.88) and in-hospital mortality (weighted risk ratio, 0.62; 95% confidence interval, 0.40-0.96). Reoperation and complication proportions did not differ significantly between the groups.

CONCLUSIONS

Perioperative vasodilator therapy was associated with reduced mortality in patients undergoing surgery for NOMI. These findings suggest that vasodilator therapy may serve as a beneficial adjunct in the surgical management of NOMI.