Elderly Patients Hospitalized with Acute Mesenteric Ischemia: A Growing Challenge
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Abstract 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 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 elderly. 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 independence was the strongest predictor of surgical intervention (OR 4.87; 95% CI: 1.92–12.49). Conclusions AMI is a severe abdominal emergency that primarily affects frail 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.
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Elderly Patients Hospitalized with Acute Mesenteric Ischemia: A Growing Challenge | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Elderly Patients Hospitalized with Acute Mesenteric Ischemia: A Growing Challenge LUIS CASTILLA-GUERRA, Paula Luque-Linero, Maria del Carmen Fernandez-Moreno, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7958096/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract 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 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 elderly. 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 independence was the strongest predictor of surgical intervention (OR 4.87; 95% CI: 1.92–12.49). Conclusions AMI is a severe abdominal emergency that primarily affects frail 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. acute mesenteric ischemia elderly patients very elderly frailty multidisciplinary care Figures Figure 1 Key Summary Points Aim: To evaluate the clinical profile, management, and outcomes of patients hospitalized with acute mesenteric ischemia (AMI). Findings: AMI predominantly affects older adults with multiple comorbidities and frailty. Most patients received conservative management, and in-hospital mortality reached 62.4%, rising to 70.1% in the very elderly. Baseline functional independence was the strongest predictor of surgical intervention. Message: Early recognition of AMI supported by comprehensive geriatric assessment and multidisciplinary collaboration is crucial to improve outcomes. Enhancing internists’ and geriatricians’ training in the identification and holistic management of these patients may optimize care and align treatment decisions with patients’ goals and overall prognosis. INTRODUCTION Acute mesenteric ischemia (AMI) represents a severe abdominal emergency caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall [ 1 ]. This condition poses a diagnostic challenge due to its nonspecific clinical presentation and potentially fatal consequences if not promptly identified and managed [ 2 ]. In fact, despite advancements in medical imaging and therapeutic strategies, AMI remains a life-threatening condition associated with high mortality rates (50 to 80%) [ 1 , 2 ]. The incidence of AMI increases exponentially with age and comorbidities making it more common in the elderly [ 2 ]. Thus, the incidence of AMI is roughly 10-fold in an 80-year-old than in a 60-year-old patient [ 3 ]. Furthermore, AMI is actually a more common cause of acute abdomen than ruptured abdominal aortic aneurysm, pancreatitis, or appendicitis in patients older than 75 years of age [ 4 ]. The aging population worldwide has led to a notable rise in the incidence of AMI among elderly hospitalized patients. This demographic shift presents a unique set of clinical, diagnostic, and therapeutic challenges, requiring a comprehensive understanding and tailored approach from internists to effectively manage this condition. Though patients with AMI are primarily managed in surgical or critical care settings [ 5 ] once they are stabilized, in non-surgical cases of AMI, they can be transferred to the general ward. Geriatrics and Internists may be involved in these specific contexts, especially for managing underlying comorbidities, optimizing medical conditions, or providing supportive care in non-surgical cases. Therefore, although most hospital systems aim to admit patients with AMI to surgical or vascular services, a significant proportion are ultimately admitted to general medicine services. Additionally, some older patients develop AMI during their hospital stay. This retrospective clinical study aimed to determine the proportion of patients with AMI who are admitted to Medicine services in current clinical practice, as well as to define the specific profile of these patients METHODS Study Design and Participants This retrospective, multicenter observational study analyzed all adult patients admitted to hospitals with AMI across 10 hospitals in Andalusia (Southern Spain) between January 1, 2010, and December 31, 2020. AMI diagnosis was confirmed using at least one of the following methods: computed tomography angiography, arteriography, or surgery. Exclusion criteria included patients under 18 years of age and those with ischemia caused by extrinsic compression of the mesenteric vessels (e.g., intestinal obstruction, volvulus, compressive tumor, abdominal compartment syndrome, etc.). Data collected included baseline demographic information, comorbidities, vital signs, radiological findings, laboratory values, and clinical outcomes during the index hospitalization. Laboratory values represent the most abnormal result within the 24 hours preceding the diagnosis. Ethics Aspects The study was conducted in accordance with the principles of the Declaration of Helsinki and current Good Clinical Practice guidelines. The research protocol was approved by the ethics committee of Hospital Virgen Macarena, Seville, Spain. Statistical Analysis Statistical significance was defined as p < 0.05. Data are presented as mean ± standard deviation (SD) or median ± interquartile range (IQR), depending on the normality of the distribution. Normality was evaluated using Shapiro- Wilk test and complemented by visual assessment of Q-Q plots. Comparisons were made using the Student’s t-test or the Wilcoxon rank-sum test, depending on the distribution. Correlation and collinearity between numerical variables were analyzed using Pearson’s correlation coefficient. Categorical variables are presented as number (n) and percentage (%), with comparisons made using Fisher’s exact test. IBM SPSS Statistics, version 28 (SPSS, Chicago, IL, USA) was used for statistical analysis. RESULTS We studied 693 patients, of whom 360 (54.2%) were women. The median age was 77.8 years (Standard Deviation -SD- ±12). A total of 595 patients (85.8%) were aged ≥ 65 years, and 221 (31.8%) were aged ≥ 85 years (classified as Very Elderly – VE– patients). The in-hospital mortality rate was 62.4%, with a higher mortality rate of 70.1% among VE patients. Most patients requiring hospitalization were admitted to Geriatric or Internal Medicine departments (434 patients, 62.6%), while 110 patients (15.8%) were admitted to the Surgery department, 99 patients (14.2%) to the Gastroenterology department, and 50 patients (7.2%) to other departments. Basal Characteristics of Patients Hypertension was the most common cardiovascular risk factor (77%), followed by diabetes mellitus (DM) (43%), dyslipidemia (41%), smoking (30.7%), and obesity (21%). A total of 432 patients (74.1%) who suffered from intestinal ischemia already had a history of cardiovascular disease, including ischemic heart disease (28%), stroke (21%), and peripheral arterial disease (25.1%). Other prevalent conditions among the analyzed patients included chronic kidney disease (33.8%), heart failure (25.8%), atrial fibrillation (28.7%), and neoplasia (12.9%). Demographic and personal background characteristics are summarized in Table 1 . Notably, one in three patients was a very elderly (VE) patient, with a mean age of 89.2 (± 3) years, most of whom were women (67.4%). Among these VE patients, 75% had some form of dependency, and one-third had dementia. Table 1 Baseline characteristics of patients with AMI Baseline Characteristics All (n = 693) ≥ 65 y (n = 595) ≥ 85 y (n = 221) Age (years; SD) 77,8 (± 12) 81,7 (± 7) 89,2 (± 3) Female 54.3% 57.5% * 67.4% * Hypertension 77% 81.4% * 82.2% * Diabetes 43.9% 46.9% 40.8% Dyslipemia 41% 41.7% 33% * Smoking 30.7% 25.8% * 21.1% * Obesity 21% 22.1% 17.7% AF 28.7% 32.2% * 33.6% * IHD 28% 28.5% 23.9% Stroke 21.4% 22.6% 26.2% PAD 25.1% 24% 14% * HF 25.8% 27.4% 27% CKD 33.8% 34.7% 37.4% Dementia 17.6% 20,4% * 30.4% * Dependency** 50.9% 57.7% * 75% * Hospital stay (Days; SD) 11.1(± 16) 10.4(± 15)* 9,3(± 18)* Mortality 62.4% 64.6% * 70.3% * AMI: Acute Mesenteric Ischemia; AF: Atrial fibrillation; IHD: Ischemic Heart Disease; PAD: Peripheral Arterial Disease; HF = Heart Failure; CKD: Chronic Kidney Disease * = P < 0.05- As compared with the total population ** Dependency- Any Day Living Activity When examining patient admissions by subspecialty (Table 2 )—Internal Medicine, Surgery, and Gastroenterology—patients admitted to Internal Medicine services were older, with a mean age of 80 (± 11) years compared to 75 (± 11) years and 73 (± 12) years, respectively (p < 0.001). They also had a higher incidence of dementia (24.9% vs. 4.5% vs. 7.5%; p < 0.001) and dependency in basic activities of daily living (57.8% vs. 30.4% vs. 40%; p < 0.001). Table 2 Characteristics of patients with AMI according to the admitting service Characteristics Internal Medicine (n = 434) Surgery (n = 110) Gastroenterology (n = 99) Age (years; SD) 80 (± 11) 75(± 11)* 73(± 12)* Very Elderly 44% 29.1%* 12.1%* Female 59.6% 45.5% * 46.3% * Hypertension 78.8% 79.1% 73.2% Diabetes 44% 44.5% 48.8% Dyslipemia 42.8% 33.9% 53.7% Smoking 28.3% 29.3% 43.6% Obesity 21.5% 19.6% 27.8% AF 30.6% 30% * 22% * IHD 27.6% 26.4% 36.6% Stroke 22.5% 19.1% 17.5% PAD 22.7% 20% 50% * HF 25.8% 20.9% 30% CKD 33.6% 23.9% 29.3% Dementia 24.9% 4.5% * 7.5% * Dependency 57.8% 30.4% * 40% * Hospital stay (Days; SD) 10.6(± 15) 10.6(± 17) 10.5(± 7) Mortality 59.6% 77.3% * 46.3% * AMI: Acute Mesenteric Ischemia AF: Atrial fibrillation; IHD: Ischemic Heart Disease; PAD: Peripheral Arterial Disease; HF = Heart Failure; CKD: Chronic Kidney Disease * = P < 0.05- As compared with the Internal Medicine patients ** Dependency- Any Day Living Activity Table 3 Comparison of patient characteristics based on treatment modality General Characteristics No Surgery (n = 563) Surgery (n = 130) P Male Gender % 43.5% 56.9% 0.006 Age (years) 79 ± 11 73 ± 11 0.001 Hypertension (mm Hg) 79.6% 80.5% 0.19 Type 2 Diabetes 42.1% 38.8% 0.002 Dyslipidemia 42.1% 38.8% 0.69 Active Smoker 30.6% 29.5% 0.76 Obesity (BMI > 30) 21.7% 21.9% 0.53 Alcohol Use Disorder 14.8% 12.8% 0.59 Ischemic Heart Disease 28.9% 24.4% 0.51 Cerebrovascular Accident 23% 15.4% 0.06 Chronic Kidney Disease 36.2% 26.7% 0.069 Heart Failure 28.1% 16.9% 0.024 Atrial Fibrillation 30.1% 23.1% 0.11 Previous Amputation 4.9% 0% 0.01 History of Oncological Disease 13.2% 10.2% 0.36 PAD (Peripheral Artery Disease) 25.1% 21.5% 0.39 Dementia 21% 1.6% 0.001 Dependency 56.4% 23.1% 0.001 Symptoms Vomiting 40.6% 41.8% 0.81 Abdominal Distension 37.7% 42.6% 0.078 Constipation 20.5% 21.4% 0.82 Rectal Bleeding 15.8% 10.7% 0.14 Hematemesis 7.1% 6.2% 0.71 Peritonism 21.2% 29.9% 0.032 Abdominal Pain 70.4% 85.9% 0.001 Fever 20.9% 17.3% 0.35 Hypotension 34.7% 34.3% 0.93 Laboratory Parameters Creatinine (mg/dL) 2.97 (1.3–3.15) 4.69 (1.71-9) 0.343 CPK (U/L) 300 (61–700) 234 (84–800) 0.69 LDH (U/L) 298 (226–390) 292 (236–532) 0.67 Urea (mg/dL) 74 (51.1–132) 76 (56–116) 0.72 pH 7.35 (7.23–7.42) 7.31 (7.2–7.39) 0.03 CRP (mg/g) 120 (50–200) 115 (27–229) 0.81 Lactic Acid (mg/dL) 17 (5.5–34) 11 (3.2-25.25) 0.049 Glucose (mg/dL) 139 (107–196) 145 (108–206) 0.392 Leukocytes (cells/µL) 15000 (10650–19650) 17925 (10115–26312) 0.21 CPK (U/L) = Creatine Phosphokinase; LDH (U/L); Lactate Dehydrogenase; CRP (mg/g) = C-reactive Protein Additionally, the percentage of VE patients was significantly higher in Internal Medicine (191 patients, 44.1%), compared to Surgery (32 patients, 29.1%) and Gastroenterology (12 patients, 12.1%) (p < 0.001). Conversely, the mortality rate of patients admitted to Geriatric or Internal Medicine was lower than those admitted to Surgery and Gastroenterology services (59.6% vs. 77.3% vs. 46.3%). Treatment Used Most patients received conservative treatment. Only 130 patients (18.5%) underwent surgery, 55 patients (7.9%) received endovascular treatment, and 20 patients (2.8%) underwent both treatments. Less than one-quarter of the patients were ultimately admitted to the ICU: 157 patients (22.6%). Compared to younger patients, VE patients’ treatment differed significantly: only 18 patients (8.1%) underwent surgery (p < 0.001), and 4 patients (1.8%) received endovascular treatment (p < 0.001). However, 45 patients (20.3%) were admitted to the ICU, with no significant differences (NS). Variables Related to Surgery Being male (p = 0.006) and younger (p = 0.0001) favored the use of a surgical technique. Among personal medical history factors, the following were significant for not being a candidate for surgery: diabetes (p = 0.002), a history of stroke (p = 0.06), heart failure (p = 0.024), a prior amputation (p = 0.01), dementia (p = 0.001), and a dependent baseline status (p = 0.001). Regarding symptoms, peritonism (p = 0.003) and abdominal pain (p = 0.001) were significant factors influencing the decision to opt for abdominal surgery. Other symptoms were not significant. With respect to laboratory parameters, lower pH and lactic acid levels were statistically significant, indicating poor perfusion (p = 0.003 and p = 0.049, respectively). In the multivariate analysis, all variables with p > 0.25 were included. Only an independent baseline status (p = 0.001, OR: 4.87, 95% CI: 1.92–12.49) was significantly associated with the surgical technique. DISCUSSION AMI is a rare but serious condition associated with significant morbidity and mortality, particularly among elderly and VE patients [ 3 – 5 ]. Our study highlights a higher-than-expected incidence of acute mesenteric ischemia (AMI) within general medical wards, a finding that can be attributed to several factors, including its nonspecific presentation and the characteristics of the elderly population predominantly served in these settings. This demographic group presents a high prevalence of comorbidities such as atrial fibrillation, heart failure, chronic kidney disease, and other vascular pathologies, all of which increase susceptibility to mesenteric ischemia. Furthermore, as demonstrated in our study, older adults frequently experience higher rates of AMI and poorer prognoses, largely due to delayed diagnosis and a greater reliance on conservative treatment approaches. The increasing number of very elderly (VE) patients admitted to general medical services is a notable trend observed across healthcare systems worldwide. This demographic shift is mainly driven by population aging, advances in medical care, and improved management of chronic conditions, all of which have contributed to longer life expectancy. Consequently, health services are now caring for a growing proportion of VE individual, typically defined as those aged 85 years and older, whose clinical complexity and vulnerability demand a comprehensive, multidisciplinary approach to diagnosis and treatment [ 6 ]. Additionally, the population of frail and multimorbid elderly patients is expanding due to ongoing improvements in medical care and rising life expectancy. These patients are often admitted to internal medicine or geriatric wards due to the complexity of their medical conditions [ 7 ]. Our study also reveals significant differences in the disease profiles of patients with AMI based on the admitting service (surgical versus medical). Patients admitted to medical wards were older, with a mean age of 80 (± 11) years, and had a higher incidence of dementia and dependency: one in three patients had dementia, and more than half were dependent on activities of daily living. Furthermore, the proportion of VE patients was much higher in internal medicine services, reaching 44% of the population, significantly exceeding the percentage of VE patients in surgery or gastroenterology. Our study also highlights the factors influencing a patient’s eligibility for surgery. Demographic factors such as younger age and male sex were associated with a higher likelihood of undergoing surgery. Conversely, factors associated with ineligibility included diabetes, prior stroke, heart failure, previous amputation, dementia, and a dependent baseline status. Symptoms influencing surgical decisions included peritonism and abdominal pain. Among laboratory parameters, lower pH and lactic acid levels were notable. However, in multivariate analysis, only an independent baseline status remained significantly associated with surgical intervention. In fact, the impact of baseline health status such as frailty, multiple chronic conditions, or multimorbidity on outcomes after Emergency General Surgery (EGS) admission is increasingly being acknowledged [ 8 ]. In a recent study, researchers analyzed data from 1,960 older adults (median age 79) in the Medicare Current Beneficiary Survey (1992–2013) who were admitted for EGS. Authors found that functional limitations were a stronger predictor of long-term survival after EGS in older adults than chronic diseases or geriatric syndromes [ 9 ]. AMI is a life-threatening condition that occurs when there is a sudden decrease in blood flow to the intestines, leading to ischemia and, potentially, necrosis of the bowel. As we have previously commented, elderly and VE patients are particularly vulnerable to this condition due to multiple factors, including pre-existing cardiovascular disease, atrial fibrillation, and a higher prevalence of atherosclerosis [ 4 ]. Despite the severe nature of AMI and the clear indications for surgical intervention in many cases, elderly patients often do not receive timely or accurate surgical treatment. This phenomenon can be attributed to several factors, including diagnostic challenges, comorbidities, delays in clinical recognition, and a tendency towards conservative management in this age group [ 4 ]. Elderly patients often present with multiple comorbidities, such as cardiovascular disease, chronic obstructive pulmonary disease, and renal insufficiency, which can complicate surgical decision-making. Surgeons and clinicians may view these patients as having an excessively high surgical risk, favoring conservative or non-operative management even when surgery is warranted [ 4 ]. Additionally, elderly patients typically have reduced physiological reserve, increasing their susceptibility to postoperative complications, such as sepsis, respiratory failure, and renal dysfunction. This elevated risk profile can discourage clinicians from pursuing aggressive surgical interventions, particularly when a definitive diagnosis is lacking or in cases of extensive bowel necrosis where the potential benefits of surgery are deemed minimal [ 10 ]. Taken together, these findings underscore the need for a multidisciplinary approach involving geriatricians, general physicians, surgeons, and intensivists to optimize individualized care pathways for older adults. Moreover, the considerable proportion of cases managed within general medical wards highlights the importance of increasing awareness and specific training in the recognition and management of AMI among healthcare professionals caring for frail and very elderly patients. This is particularly relevant in the context of population aging and the rising incidence of mesenteric ischemia in geriatric populations, where timely diagnosis and coordinated decision-making are crucial to improving outcomes. Our analysis has several important limitations. First, this study was retrospective in nature, which inherently limits the ability to establish causal relationships between clinical variables and outcomes. The study did not employ uniform diagnostic protocols (e.g., criteria for imaging or laboratory thresholds), nor were therapeutic decisions standardized across departments. This heterogeneity could introduce bias, particularly when comparing outcomes between patients admitted to different hospital departments. Crucial variables such as time from symptom onset to diagnosis, timing of intervention (if any), and delays in imaging or surgical decision-making were not analyzed. These time-sensitive factors are known to significantly impact outcomes in AMI and may confound interpretation of mortality and treatment rates. Moreover, the study did not differentiate between the types of AMI (e.g., arterial embolism, arterial thrombosis, non-occlusive mesenteric ischemia, or venous thrombosis). Each etiology has different clinical courses, prognoses, and treatment options, and aggregating them may mask clinically meaningful differences. Finally, only a small proportion of patients received endovascular therapy or ICU care, which may reflect limited access, physician preferences, or selection bias. This underrepresentation could skew the generalizability of the findings regarding modern interventional approaches. Despite these limitations, the study benefits from a large patient sample and a multicenter design, yielding robust and comprehensive results. Therefore, it offers valuable guidance for future investigations into the role of internal medicine in patients with AMI. CONCLUSIONS AMI predominantly affects elderly and VE patients with multiple cardiovascular comorbidities, high levels of functional dependency, and dementia. Notably, the majority of patients with AMI are admitted to medical services, where they tend to be older, more frail, and receive more conservative treatment approaches. In-hospital mortality remains critically high, particularly among VE patients, highlighting the severity of AMI and emphasizing the necessity for early diagnosis and individualized management approaches. Surgical intervention is more commonly performed in younger, functionally independent patients presenting with clear clinical evidence of bowel ischemia, whereas frailty and comorbidities considerably restrict surgical eligibility. Baseline functional status emerges as a key independent predictor for candidacy for surgical treatment, underscoring the vital role of comprehensive geriatric assessment in the management of AMI. Collectively, these findings advocate for a multidisciplinary approach involving internists, surgeons, and intensivists to optimize personalized care pathways. Moreover, the considerable number of patients admitted to medical wards underscores the need to enhance awareness and specialized training in AMI management among geritricians and internists, particularly in light of the aging population and increasing incidence of this condition. Declarations Bullets The majority of patients with AMI are admitted to internal medicine services. AMI predominantly affects elderly and VE patients with multiple comorbidities, functional dependency and dementia. In-hospital mortality remains alarmingly high, particularly in VE patients Interdisciplinary collaboration and education for internists are critical to improving outcomes in this population . Funding: This research received no external funding. Conflicts of Interest: The authors declare no conflicts of interest. References Clair DG, Beach JM (2016) Mesenteric Ischemia. 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World J Emerg Surg 17:54. https://doi.org/10.1186/s13017-022-00443-x Moond V, Shahi P, Goel A (2020) Gray Transformation of Internal Medicine. Cureus 12(8):e9754. 10.7759/cureus.9754 PMID: 32944469; PMCID: PMC7489770 Lea M, Mowe M, Mathiesen L, Kvernrød K, Skovlund E, Molden E (2019) Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward. PLoS ONE 14(7):e0220071. 10.1371/journal.pone.0220071 PMID: 31329634; PMCID: PMC6645516 Lee KC, Streid J, Sturgeon D, Lipsitz S, Weissman JS et al The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study. J Am Geriatr Soc 2020:68:1037–1043 Ho VP, Bensken WP, Flippin JA, Santry HP, Claridge JA, Towe CW, Koroukian SM (2023) Functional Status is Key to Long-term Survival in Emergency General Surgery Conditions. J Surg Res 283:224–232 Tran LM, Andraska E, Haga L, Sridharan N, Chaer RA, Eslami MH (2022) Hospital-based delays to revascularization increase risk of postoperative mortality and short bowel syndrome in acute mesenteric ischemia. J Vasc Surg 75(4):1323–1333e3. 10.1016/j.jvs.2021.09.033 Epub 2021 Oct 8. PMID: 34634418; PMCID: PMC8991435 Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 05 Nov, 2025 Reviewers invited by journal 05 Nov, 2025 Editor assigned by journal 01 Nov, 2025 First submitted to journal 29 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Malaga","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Dolores","lastName":"Martínez-Esteban","suffix":""},{"id":540231444,"identity":"ddff458d-3221-48fb-a35e-a67bae7e8a17","order_by":6,"name":"Maria del Pilar Segura-Torres","email":"","orcid":"","institution":"Complejo Hospitalario de Jaén: Complejo Hospitalario de Jaen","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"del Pilar","lastName":"Segura-Torres","suffix":""},{"id":540231445,"identity":"f5bf6c77-6a0a-4058-809a-9ff5cffcc120","order_by":7,"name":"Maria Dolores López Carmona","email":"","orcid":"","institution":"Hospital Regional Universitario de Málaga: Hospital Regional Universitario de Malaga","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Dolores López","lastName":"Carmona","suffix":""},{"id":540231446,"identity":"b6433fc5-84d9-40a8-b2e3-970608e4966f","order_by":8,"name":"Juan Diego Mediavilla","email":"","orcid":"","institution":"Complejo Hospitalario Virgen de las Nieves: Hospital Universitario Virgen de las Nieves","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Diego","lastName":"Mediavilla","suffix":""}],"badges":[],"createdAt":"2025-10-27 12:20:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7958096/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7958096/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95939570,"identity":"e517b09a-b158-4690-9c9b-4eaf01332680","added_by":"auto","created_at":"2025-11-14 16:08:10","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":12105,"visible":true,"origin":"","legend":"","description":"","filename":"egemEGEMD2501424.xml","url":"https://assets-eu.researchsquare.com/files/rs-7958096/v1/167096d66e552915ba3f971b.xml"},{"id":95939566,"identity":"f8cb4e1f-37ad-4bc6-90aa-dca84205690a","added_by":"auto","created_at":"2025-11-14 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16:08:10","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94387,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7958096/v1/51c36128496ab768aa481c5a.html"},{"id":95939563,"identity":"75eb443b-bbbb-41f5-a97d-1ab9cffb3e1d","added_by":"auto","created_at":"2025-11-14 16:08:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13091,"visible":true,"origin":"","legend":"\u003cp\u003eTreatments used according to the admitting service.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7958096/v1/a2416ef78953215a1d170479.png"},{"id":96363113,"identity":"dcc5b701-baf4-48ee-b6fe-c272f8181467","added_by":"auto","created_at":"2025-11-20 10:04:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":843372,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7958096/v1/a94f541a-210d-46a4-9b76-1dd80ba5bf41.pdf"}],"financialInterests":"","formattedTitle":"Elderly Patients Hospitalized with Acute Mesenteric Ischemia: A Growing Challenge ","fulltext":[{"header":"Key Summary Points","content":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To evaluate the clinical profile, management, and outcomes of patients hospitalized with acute mesenteric ischemia (AMI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e AMI predominantly affects older adults with multiple comorbidities and frailty. Most patients received conservative management, and in-hospital mortality reached 62.4%, rising to 70.1% in the very elderly. Baseline functional independence was the strongest predictor of surgical intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMessage:\u003c/strong\u003e Early recognition of AMI supported by comprehensive geriatric assessment and multidisciplinary collaboration is crucial to improve outcomes. Enhancing internists\u0026rsquo; and geriatricians\u0026rsquo; training in the identification and holistic management of these patients may optimize care and align treatment decisions with patients\u0026rsquo; goals and overall prognosis.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eAcute mesenteric ischemia (AMI) represents a severe abdominal emergency caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis condition poses a diagnostic challenge due to its nonspecific clinical presentation and potentially fatal consequences if not promptly identified and managed [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn fact, despite advancements in medical imaging and therapeutic strategies, AMI remains a life-threatening condition associated with high mortality rates (50 to 80%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe incidence of AMI increases exponentially with age and comorbidities making it more common in the elderly [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Thus, the incidence of AMI is roughly 10-fold in an 80-year-old than in a 60-year-old patient [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, AMI is actually a more common cause of acute abdomen than ruptured abdominal aortic aneurysm, pancreatitis, or appendicitis in patients older than 75 years of age [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe aging population worldwide has led to a notable rise in the incidence of AMI among elderly hospitalized patients. This demographic shift presents a unique set of clinical, diagnostic, and therapeutic challenges, requiring a comprehensive understanding and tailored approach from internists to effectively manage this condition.\u003c/p\u003e\u003cp\u003eThough patients with AMI are primarily managed in surgical or critical care settings [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] once they are stabilized, in non-surgical cases of AMI, they can be transferred to the general ward. Geriatrics and Internists may be involved in these specific contexts, especially for managing underlying comorbidities, optimizing medical conditions, or providing supportive care in non-surgical cases.\u003c/p\u003e\u003cp\u003eTherefore, although most hospital systems aim to admit patients with AMI to surgical or vascular services, a significant proportion are ultimately admitted to general medicine services. Additionally, some older patients develop AMI during their hospital stay.\u003c/p\u003e\u003cp\u003eThis retrospective clinical study aimed to determine the proportion of patients with AMI who are admitted to Medicine services in current clinical practice, as well as to define the specific profile of these patients\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThis retrospective, multicenter observational study analyzed all adult patients admitted to hospitals with AMI across 10 hospitals in Andalusia (Southern Spain) between January 1, 2010, and December 31, 2020.\u003c/p\u003e\u003cp\u003eAMI diagnosis was confirmed using at least one of the following methods: computed tomography angiography, arteriography, or surgery. Exclusion criteria included patients under 18 years of age and those with ischemia caused by extrinsic compression of the mesenteric vessels (e.g., intestinal obstruction, volvulus, compressive tumor, abdominal compartment syndrome, etc.).\u003c/p\u003e\u003cp\u003eData collected included baseline demographic information, comorbidities, vital signs, radiological findings, laboratory values, and clinical outcomes during the index hospitalization. Laboratory values represent the most abnormal result within the 24 hours preceding the diagnosis.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthics Aspects\u003c/h3\u003e\n\u003cp\u003e The study was conducted in accordance with the principles of the Declaration of Helsinki and current Good Clinical Practice guidelines. The research protocol was approved by the ethics committee of Hospital Virgen Macarena, Seville, Spain.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median\u0026thinsp;\u0026plusmn;\u0026thinsp;interquartile range (IQR), depending on the normality of the distribution. Normality was evaluated using Shapiro- Wilk test and complemented by visual assessment of Q-Q plots. Comparisons were made using the Student\u0026rsquo;s t-test or the Wilcoxon rank-sum test, depending on the distribution. Correlation and collinearity between numerical variables were analyzed using Pearson\u0026rsquo;s correlation coefficient. Categorical variables are presented as number (n) and percentage (%), with comparisons made using Fisher\u0026rsquo;s exact test. IBM SPSS Statistics, version 28 (SPSS, Chicago, IL, USA) was used for statistical analysis.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe studied 693 patients, of whom 360 (54.2%) were women. The median age was 77.8 years (Standard Deviation -SD- \u0026plusmn;12). A total of 595 patients (85.8%) were aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, and 221 (31.8%) were aged\u0026thinsp;\u0026ge;\u0026thinsp;85 years (classified as Very Elderly \u0026ndash; VE\u0026ndash; patients). The in-hospital mortality rate was 62.4%, with a higher mortality rate of 70.1% among VE patients.\u003c/p\u003e\u003cp\u003eMost patients requiring hospitalization were admitted to Geriatric or Internal Medicine departments (434 patients, 62.6%), while 110 patients (15.8%) were admitted to the Surgery department, 99 patients (14.2%) to the Gastroenterology department, and 50 patients (7.2%) to other departments.\u003c/p\u003e\n\u003ch3\u003eBasal Characteristics of Patients\u003c/h3\u003e\n\u003cp\u003eHypertension was the most common cardiovascular risk factor (77%), followed by diabetes mellitus (DM) (43%), dyslipidemia (41%), smoking (30.7%), and obesity (21%). A total of 432 patients (74.1%) who suffered from intestinal ischemia already had a history of cardiovascular disease, including ischemic heart disease (28%), stroke (21%), and peripheral arterial disease (25.1%). Other prevalent conditions among the analyzed patients included chronic kidney disease (33.8%), heart failure (25.8%), atrial fibrillation (28.7%), and neoplasia (12.9%).\u003c/p\u003e\u003cp\u003eDemographic and personal background characteristics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Notably, one in three patients was a very elderly (VE) patient, with a mean age of 89.2 (\u0026plusmn;\u0026thinsp;3) years, most of whom were women (67.4%). Among these VE patients, 75% had some form of dependency, and one-third had dementia.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of patients with AMI\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline Characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;693)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;65 y\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;595)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;85 y\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;221)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years; SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77,8 (\u0026plusmn;\u0026thinsp;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81,7 (\u0026plusmn;\u0026thinsp;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89,2 (\u0026plusmn;\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.5%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e67.4%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.4%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82.2%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.8%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21.1%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.2%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33.6%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIHD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePAD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e37.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20,4%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30.4%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependency**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.7%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital stay (Days; SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.1(\u0026plusmn;\u0026thinsp;16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.4(\u0026plusmn;\u0026thinsp;15)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9,3(\u0026plusmn;\u0026thinsp;18)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64.6%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70.3%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eAMI: Acute Mesenteric Ischemia; AF: Atrial fibrillation; IHD: Ischemic Heart Disease; PAD: Peripheral Arterial Disease; HF\u0026thinsp;=\u0026thinsp;Heart Failure; CKD: Chronic Kidney Disease\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* = P\u0026thinsp;\u0026lt;\u0026thinsp;0.05- As compared with the total population\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e** Dependency- Any Day Living Activity\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen examining patient admissions by subspecialty (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u0026mdash;Internal Medicine, Surgery, and Gastroenterology\u0026mdash;patients admitted to Internal Medicine services were older, with a mean age of 80 (\u0026plusmn;\u0026thinsp;11) years compared to 75 (\u0026plusmn;\u0026thinsp;11) years and 73 (\u0026plusmn;\u0026thinsp;12) years, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). They also had a higher incidence of dementia (24.9% vs. 4.5% vs. 7.5%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and dependency in basic activities of daily living (57.8% vs. 30.4% vs. 40%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of patients with AMI according to the admitting service\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;110)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGastroenterology\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;99)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years; SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (\u0026plusmn;\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75(\u0026plusmn;\u0026thinsp;11)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73(\u0026plusmn;\u0026thinsp;12)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery Elderly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.1%*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.1%*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.5%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46.3%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIHD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePAD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.5%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.4%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital stay (Days; SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.6(\u0026plusmn;\u0026thinsp;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.6(\u0026plusmn;\u0026thinsp;17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.5(\u0026plusmn;\u0026thinsp;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77.3%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46.3%\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eAMI: Acute Mesenteric Ischemia AF: Atrial fibrillation; IHD: Ischemic Heart Disease; PAD: Peripheral Arterial Disease; HF\u0026thinsp;=\u0026thinsp;Heart Failure; CKD: Chronic Kidney Disease\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e* = P\u0026thinsp;\u0026lt;\u0026thinsp;0.05- As compared with the Internal Medicine patients\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e** Dependency- Any Day Living Activity\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of patient characteristics based on treatment modality\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral Characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo Surgery\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;563)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale Gender %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension (mm Hg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 2 Diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActive Smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObesity (BMI\u0026thinsp;\u0026gt;\u0026thinsp;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Use Disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIschemic Heart Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebrovascular Accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic Kidney Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart Failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial Fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious Amputation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of Oncological Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePAD (Peripheral Artery Disease)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDementia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSymptoms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVomiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Distension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstipation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRectal Bleeding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematemesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeritonism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypotension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLaboratory Parameters\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.97 (1.3\u0026ndash;3.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.69 (1.71-9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.343\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCPK (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e300 (61\u0026ndash;700)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e234 (84\u0026ndash;800)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e298 (226\u0026ndash;390)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e292 (236\u0026ndash;532)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (51.1\u0026ndash;132)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (56\u0026ndash;116)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.35 (7.23\u0026ndash;7.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.31 (7.2\u0026ndash;7.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP (mg/g)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120 (50\u0026ndash;200)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e115 (27\u0026ndash;229)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLactic Acid (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (5.5\u0026ndash;34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (3.2-25.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlucose (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e139 (107\u0026ndash;196)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145 (108\u0026ndash;206)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.392\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeukocytes (cells/\u0026micro;L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15000 (10650\u0026ndash;19650)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17925 (10115\u0026ndash;26312)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eCPK (U/L)\u0026thinsp;=\u0026thinsp;Creatine Phosphokinase; LDH (U/L); Lactate Dehydrogenase; CRP (mg/g)\u0026thinsp;=\u0026thinsp;C-reactive Protein\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAdditionally, the percentage of VE patients was significantly higher in Internal Medicine (191 patients, 44.1%), compared to Surgery (32 patients, 29.1%) and Gastroenterology (12 patients, 12.1%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, the mortality rate of patients admitted to Geriatric or Internal Medicine was lower than those admitted to Surgery and Gastroenterology services (59.6% vs. 77.3% vs. 46.3%).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTreatment Used\u003c/h2\u003e\u003cp\u003eMost patients received conservative treatment. Only 130 patients (18.5%) underwent surgery, 55 patients (7.9%) received endovascular treatment, and 20 patients (2.8%) underwent both treatments. Less than one-quarter of the patients were ultimately admitted to the ICU: 157 patients (22.6%). Compared to younger patients, VE patients\u0026rsquo; treatment differed significantly: only 18 patients (8.1%) underwent surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 4 patients (1.8%) received endovascular treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, 45 patients (20.3%) were admitted to the ICU, with no significant differences (NS).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables Related to Surgery\u003c/h3\u003e\n\u003cp\u003eBeing male (p\u0026thinsp;=\u0026thinsp;0.006) and younger (p\u0026thinsp;=\u0026thinsp;0.0001) favored the use of a surgical technique. Among personal medical history factors, the following were significant for not being a candidate for surgery: diabetes (p\u0026thinsp;=\u0026thinsp;0.002), a history of stroke (p\u0026thinsp;=\u0026thinsp;0.06), heart failure (p\u0026thinsp;=\u0026thinsp;0.024), a prior amputation (p\u0026thinsp;=\u0026thinsp;0.01), dementia (p\u0026thinsp;=\u0026thinsp;0.001), and a dependent baseline status (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eRegarding symptoms, peritonism (p\u0026thinsp;=\u0026thinsp;0.003) and abdominal pain (p\u0026thinsp;=\u0026thinsp;0.001) were significant factors influencing the decision to opt for abdominal surgery. Other symptoms were not significant.\u003c/p\u003e\u003cp\u003eWith respect to laboratory parameters, lower pH and lactic acid levels were statistically significant, indicating poor perfusion (p\u0026thinsp;=\u0026thinsp;0.003 and p\u0026thinsp;=\u0026thinsp;0.049, respectively).\u003c/p\u003e\u003cp\u003eIn the multivariate analysis, all variables with p\u0026thinsp;\u0026gt;\u0026thinsp;0.25 were included. Only an independent baseline status (p\u0026thinsp;=\u0026thinsp;0.001, OR: 4.87, 95% CI: 1.92\u0026ndash;12.49) was significantly associated with the surgical technique.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAMI is a rare but serious condition associated with significant morbidity and mortality, particularly among elderly and VE patients [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study highlights a higher-than-expected incidence of acute mesenteric ischemia (AMI) within general medical wards, a finding that can be attributed to several factors, including its nonspecific presentation and the characteristics of the elderly population predominantly served in these settings. This demographic group presents a high prevalence of comorbidities such as atrial fibrillation, heart failure, chronic kidney disease, and other vascular pathologies, all of which increase susceptibility to mesenteric ischemia. Furthermore, as demonstrated in our study, older adults frequently experience higher rates of AMI and poorer prognoses, largely due to delayed diagnosis and a greater reliance on conservative treatment approaches.\u003c/p\u003e\u003cp\u003eThe increasing number of very elderly (VE) patients admitted to general medical services is a notable trend observed across healthcare systems worldwide. This demographic shift is mainly driven by population aging, advances in medical care, and improved management of chronic conditions, all of which have contributed to longer life expectancy. Consequently, health services are now caring for a growing proportion of VE individual, typically defined as those aged 85 years and older, whose clinical complexity and vulnerability demand a comprehensive, multidisciplinary approach to diagnosis and treatment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, the population of frail and multimorbid elderly patients is expanding due to ongoing improvements in medical care and rising life expectancy. These patients are often admitted to internal medicine or geriatric wards due to the complexity of their medical conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study also reveals significant differences in the disease profiles of patients with AMI based on the admitting service (surgical versus medical). Patients admitted to medical wards were older, with a mean age of 80 (\u0026plusmn;\u0026thinsp;11) years, and had a higher incidence of dementia and dependency: one in three patients had dementia, and more than half were dependent on activities of daily living. Furthermore, the proportion of VE patients was much higher in internal medicine services, reaching 44% of the population, significantly exceeding the percentage of VE patients in surgery or gastroenterology.\u003c/p\u003e\u003cp\u003eOur study also highlights the factors influencing a patient\u0026rsquo;s eligibility for surgery. Demographic factors such as younger age and male sex were associated with a higher likelihood of undergoing surgery. Conversely, factors associated with ineligibility included diabetes, prior stroke, heart failure, previous amputation, dementia, and a dependent baseline status. Symptoms influencing surgical decisions included peritonism and abdominal pain. Among laboratory parameters, lower pH and lactic acid levels were notable. However, in multivariate analysis, only an independent baseline status remained significantly associated with surgical intervention.\u003c/p\u003e\u003cp\u003eIn fact, the impact of baseline health status such as frailty, multiple chronic conditions, or multimorbidity on outcomes after Emergency General Surgery (EGS) admission is increasingly being acknowledged [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn a recent study, researchers analyzed data from 1,960 older adults (median age 79) in the Medicare Current Beneficiary Survey (1992\u0026ndash;2013) who were admitted for EGS. Authors found that functional limitations were a stronger predictor of long-term survival after EGS in older adults than chronic diseases or geriatric syndromes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAMI is a life-threatening condition that occurs when there is a sudden decrease in blood flow to the intestines, leading to ischemia and, potentially, necrosis of the bowel. As we have previously commented, elderly and VE patients are particularly vulnerable to this condition due to multiple factors, including pre-existing cardiovascular disease, atrial fibrillation, and a higher prevalence of atherosclerosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite the severe nature of AMI and the clear indications for surgical intervention in many cases, elderly patients often do not receive timely or accurate surgical treatment. This phenomenon can be attributed to several factors, including diagnostic challenges, comorbidities, delays in clinical recognition, and a tendency towards conservative management in this age group [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eElderly patients often present with multiple comorbidities, such as cardiovascular disease, chronic obstructive pulmonary disease, and renal insufficiency, which can complicate surgical decision-making. Surgeons and clinicians may view these patients as having an excessively high surgical risk, favoring conservative or non-operative management even when surgery is warranted [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, elderly patients typically have reduced physiological reserve, increasing their susceptibility to postoperative complications, such as sepsis, respiratory failure, and renal dysfunction. This elevated risk profile can discourage clinicians from pursuing aggressive surgical interventions, particularly when a definitive diagnosis is lacking or in cases of extensive bowel necrosis where the potential benefits of surgery are deemed minimal [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTaken together, these findings underscore the need for a multidisciplinary approach involving geriatricians, general physicians, surgeons, and intensivists to optimize individualized care pathways for older adults. Moreover, the considerable proportion of cases managed within general medical wards highlights the importance of increasing awareness and specific training in the recognition and management of AMI among healthcare professionals caring for frail and very elderly patients. This is particularly relevant in the context of population aging and the rising incidence of mesenteric ischemia in geriatric populations, where timely diagnosis and coordinated decision-making are crucial to improving outcomes.\u003c/p\u003e\u003cp\u003eOur analysis has several important limitations. First, this study was retrospective in nature, which inherently limits the ability to establish causal relationships between clinical variables and outcomes. The study did not employ uniform diagnostic protocols (e.g., criteria for imaging or laboratory thresholds), nor were therapeutic decisions standardized across departments. This heterogeneity could introduce bias, particularly when comparing outcomes between patients admitted to different hospital departments. Crucial variables such as time from symptom onset to diagnosis, timing of intervention (if any), and delays in imaging or surgical decision-making were not analyzed. These time-sensitive factors are known to significantly impact outcomes in AMI and may confound interpretation of mortality and treatment rates. Moreover, the study did not differentiate between the types of AMI (e.g., arterial embolism, arterial thrombosis, non-occlusive mesenteric ischemia, or venous thrombosis). Each etiology has different clinical courses, prognoses, and treatment options, and aggregating them may mask clinically meaningful differences. Finally, only a small proportion of patients received endovascular therapy or ICU care, which may reflect limited access, physician preferences, or selection bias. This underrepresentation could skew the generalizability of the findings regarding modern interventional approaches.\u003c/p\u003e\u003cp\u003eDespite these limitations, the study benefits from a large patient sample and a multicenter design, yielding robust and comprehensive results. Therefore, it offers valuable guidance for future investigations into the role of internal medicine in patients with AMI.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eAMI predominantly affects elderly and VE patients with multiple cardiovascular comorbidities, high levels of functional dependency, and dementia. Notably, the majority of patients with AMI are admitted to medical services, where they tend to be older, more frail, and receive more conservative treatment approaches.\u003c/p\u003e\u003cp\u003eIn-hospital mortality remains critically high, particularly among VE patients, highlighting the severity of AMI and emphasizing the necessity for early diagnosis and individualized management approaches. Surgical intervention is more commonly performed in younger, functionally independent patients presenting with clear clinical evidence of bowel ischemia, whereas frailty and comorbidities considerably restrict surgical eligibility.\u003c/p\u003e\u003cp\u003eBaseline functional status emerges as a key independent predictor for candidacy for surgical treatment, underscoring the vital role of comprehensive geriatric assessment in the management of AMI.\u003c/p\u003e\u003cp\u003eCollectively, these findings advocate for a multidisciplinary approach involving internists, surgeons, and intensivists to optimize personalized care pathways.\u003c/p\u003e\u003cp\u003eMoreover, the considerable number of patients admitted to medical wards underscores the need to enhance awareness and specialized training in AMI management among geritricians and internists, particularly in light of the aging population and increasing incidence of this condition.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eBullets\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe majority of patients with AMI are admitted to internal medicine services.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eAMI predominantly affects elderly and VE patients with multiple comorbidities, functional dependency and dementia.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eIn-hospital mortality remains alarmingly high, particularly in VE patients\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eInterdisciplinary collaboration and education for internists are critical to improving outcomes in this population\u003c/strong\u003e.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eClair DG, Beach JM (2016) Mesenteric Ischemia. N Engl J Med 374:959\u0026ndash;968. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra1503884\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1503884\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, Di Saverio S, Fraga GP, Catena F (2017) Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 12:38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13017-017-0150-5\u003c/span\u003e\u003cspan address=\"10.1186/s13017-017-0150-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eK\u0026auml;rkk\u0026auml;inen JM (2016) Acute mesenteric ischemia in elderly patients. Expert Rev Gastroenterol Hepatol 10(9):985\u0026ndash;988. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17474124.2016.1212657\u003c/span\u003e\u003cspan address=\"10.1080/17474124.2016.1212657\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eK\u0026auml;rkk\u0026auml;inen JM, Lehtim\u0026auml;ki TT, Manninen H, Paajanen H (2015) Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly. J Gastrointest Surg 19(08):1407\u0026ndash;1414\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBala M, Catena F, Kashuk J et al (2022) Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg 17:54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13017-022-00443-x\u003c/span\u003e\u003cspan address=\"10.1186/s13017-022-00443-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoond V, Shahi P, Goel A (2020) Gray Transformation of Internal Medicine. Cureus 12(8):e9754. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.9754\u003c/span\u003e\u003cspan address=\"10.7759/cureus.9754\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 32944469; PMCID: PMC7489770\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLea M, Mowe M, Mathiesen L, Kvernr\u0026oslash;d K, Skovlund E, Molden E (2019) Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward. PLoS ONE 14(7):e0220071. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0220071\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0220071\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 31329634; PMCID: PMC6645516\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee KC, Streid J, Sturgeon D, Lipsitz S, Weissman JS et al The Impact of Frailty on Long-Term Patient-Oriented Outcomes after Emergency General Surgery: A Retrospective Cohort Study. J Am Geriatr Soc 2020:68:1037\u0026ndash;1043\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHo VP, Bensken WP, Flippin JA, Santry HP, Claridge JA, Towe CW, Koroukian SM (2023) Functional Status is Key to Long-term Survival in Emergency General Surgery Conditions. J Surg Res 283:224\u0026ndash;232\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTran LM, Andraska E, Haga L, Sridharan N, Chaer RA, Eslami MH (2022) Hospital-based delays to revascularization increase risk of postoperative mortality and short bowel syndrome in acute mesenteric ischemia. J Vasc Surg 75(4):1323\u0026ndash;1333e3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvs.2021.09.033\u003c/span\u003e\u003cspan address=\"10.1016/j.jvs.2021.09.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2021 Oct 8. PMID: 34634418; PMCID: PMC8991435\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"acute mesenteric ischemia, elderly patients, very elderly, frailty, multidisciplinary care","lastPublishedDoi":"10.21203/rs.3.rs-7958096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7958096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe median age was 77.8 years; 85.8% were aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, and 31.8% were \u0026ge;\u0026thinsp;85 years. In-hospital mortality was 62.4%, increasing to 70.1% among the very elderly. 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 independence was the strongest predictor of surgical intervention (OR 4.87; 95% CI: 1.92\u0026ndash;12.49).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAMI is a severe abdominal emergency that primarily affects frail 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\u0026rsquo; overall goals and functional status.\u003c/p\u003e","manuscriptTitle":"Elderly Patients Hospitalized with Acute Mesenteric Ischemia: A Growing Challenge ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 16:08:05","doi":"10.21203/rs.3.rs-7958096/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-11-05T07:53:51+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-05T07:48:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-01T04:04:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2025-10-29T12:05:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0310d247-65a1-4e72-8f9d-507422ebaf6c","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T10:10:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 16:08:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7958096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7958096","identity":"rs-7958096","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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