Racial and Gender Disparities in the Management and Outcomes of Patients With Acute Mesenteric Ischemia: A Nationwide Retrospective Cohort Analysis

Introduction: Acute mesenteric ischemia (AMI) is often associated with poor prognosis without immediate intervention. Despite the severity of AMI, little is known regarding gender and race specific disparities in outcomes of hospitalized patients. The aim of this study was to characterize gender and race specific disparities in patients hospitalized with AMI using the U.S. National Inpatient Sample (NIS) database. Methods: A retrospective cohort study was performed on patients admitted with a primary diagnosis of AMI between January 1, 2016, and December 31, 2020, using the NIS database. Demographics, comorbidities, and in-hospital outcomes were compared between racial groups and genders. Categorical and continuous variables were analyzed with chi-squared test and multivariable linear regression, respectively. Odds ratios (ORs) for the race and gender cohorts were obtained with logistic regression models. Results: Of 99,225 patients, 55,420 (55.8%) were female. Compared to males, females had lower odds of in-hospital mortality (OR 0.93, P = 0.04), acute kidney injury (OR 0.70, P < 0.001), vasopressor use (OR 0.79, P < 0.001), invasive (OR 0.77, P < 0.001) and noninvasive mechanical ventilation (OR 0.70, P < 0.001), hemodialysis (OR 0.92, P < 0.001), venous thromboembolism (OR 0.78, P < 0.001), myocardial infarction (OR 0.80, P = 0.003), sudden cardiac arrest (OR 0.89, P = 0.002), and small bowel resection (OR 0.92, P = 0.003). Relative to White patients, Hispanic patients had significantly lower odds of inpatient mortality (OR 0.87, P = 0.04) and Native American patients had a higher risk of inpatient mortality (OR 1.64, P = 0.01). African American patients were significantly less likely to undergo percutaneous vascular intervention (OR 0.39, P < 0.001) and more likely to undergo small bowel resection (OR 1.25, P < 0.001). Conclusions: AMI has worse outcomes in males. Disparities were also observed based on the race of the patients, with a worse complication profile among certain minority groups.