Key result
Norepinephrine >64 µg/kg linked to ~40% higher colonic ischemia risk after ruptured AAA repair.
Why the study?
Perioperative and ICU variables predicting colonic ischemia after infrarenal ruptured abdominal aortic aneurysm surgery were not well defined.
Cohort (n=135)
No
High norepinephrine doses, prolonged operating times, and low pH are significant risk factors for developing colonic ischemia after ruptured abdominal aortic aneurysm surgery.
High norepinephrine doses were associated with colonic ischemia after ruptured AAA repair; hypothesis-generating and should not yet change practice.
(1) Background: This retrospective study evaluated perioperative and intensive care unit (ICU) variables to predict colonic ischemia (CI) after infrarenal ruptured abdominal aortic aneurysm (RAAA) surgery. (2) Materials and Methods: We retrospectively analyzed the data of the patients treated for infrarenal RAAA from January 2011 to December 2020 in our hospital. (3) Results: A total of 135 (82% male) patients were admitted to ICU after treatment of infrarenal RAAA. The median age of all patients was 75 years (IQR 68–81 years). Of those, 24 (18%) patients developed CI, including 22 (92%) cases within the first three postoperative days. CI was found more often after open repair compared to endovascular treatment (22% vs. 5%, p = 0.021). Laboratory findings in the first seven PODs revealed statistically significant differences between CI and non-CI patients for serum lactate, minimum pH, serum bicarbonate, and platelet count. Norepinephrine (NE) was used in 92 (68%) patients during ICU stay. The highest daily dose of norepinephrine was administered to CI patients at POD1. Multivariable analysis revealed that NE > 64 µg/kg (RD 0.40, 95% CI: 0.25–0.55, p < 0.001), operating time ≥ 200 min (RD 0.18, 95% CI: 0.05–0.31, p = 0.042), and pH < 7.3 (RD 0.21, 95% CI: 0.07–0.35, p = 0.019), significantly predicted the development of CI. A total of 23 (17%) patients died during the hospital stay, including 8 (33%) patients from the CI group and 15 (7%) from the non-CI group (p = 0.032). (4) Conclusions: CI after RAAA is a sever complication occurring most frequently within the first 3 postoperative days. Our study identified many surrogate markers associated with colonic ischemia after aortic RAAA, including norepinephrine dose > 64 µg/kg, operating time ≥ 200 min, and PH < 7.3. Future studies are needed to support these results.
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Omran et al. (2023) conducted a cohort in Infrarenal ruptured abdominal aortic aneurysm (RAAA) (n=135). Norepinephrine > 64 µg/kg vs. Norepinephrine ≤ 64 µg/kg was evaluated on Colonic ischemia (RD 0.40, 95% CI 0.25-0.55, p=<0.001). Norepinephrine dose > 64 µg/kg significantly predicted the development of colonic ischemia after ruptured abdominal aortic aneurysm surgery (RD 0.40; 95% CI 0.25-0.55; p<0.001).
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