指南建议对于年龄较轻、健康状况较好的慢性肠系膜缺血（CMI）患者，选择开放手术（OR）治疗而非内腔血管再通术（ER）。然而，至今尚不清楚这些建议在患者整体预期寿命方面的长期费用情况。本研究旨在调查这两种治疗方式之间5年价值是否存在差异。患者数据从纽约州全支付者数据库——州级规划和研究合作系统中提取，其中包含人口统计学数据、诊断、治疗和收费信息。在数据库中查询具有CMI的第九版国际疾病分类编码的患者数据，同时排除急性缺血症状的病例。对最终的患者队列进行了Charlson共病指数、年龄、性别、种族、肾功能和肺部疾病等因素的倾向性评分匹配。采用多元线性回归和混合效应线性回归来确定与5年价值相关的因素，该价值的计算方式为寿命年数/$100,000收费。收费数据来自于索引入院以及后续入院，用于急性或慢性肠系膜缺血、肠系膜血管造影或随访再介入的费用。对生存率和无再介入干预的生存率进行了Kaplan-Meier估计。从2000年到2014年，共有875名患者接受了CMI干预。符合纳入标准的患者中，209例（28.1%）接受了OR治疗，535例（71.9%）接受了ER治疗。在倾向性分数匹配后（每组n=209），ER组在术后5年的价值更高（8.04±11.42寿命年/$100,000费用 vs 4.89±5.28寿命年/$100,000费用，p<0.01）。ER组的再介入患者更多（37 vs 17例，p<0.01），ER组进行了55次再介入，而OR组进行了19次再介入（p<0.01）。多元线性回归分析显示，年龄、充血性心力衰竭、心律失常、癌症以及在重症监护病房中度过的天数与5年价值呈负相关，而ER则呈正相关。存活率分别为59.6±3.76%和62.3%±3.49%，无再介入干预的生存率分别为43.7±3.86%和58.1±3.53%（p=0.04），对于ER和OR群体。尽管再介入次数增加、无再介入干预的生存率较低，但CMI患者在5年的价值方面，经历ER的患者在迄今为止最大的倾向性分数匹配队列中价值更高。影响价值的负面因素包括OR、年龄、重症监护病房住院天数、充血性心力衰竭、心律失常和癌症。对于有合适解剖结构的患者，根据手术价值的优越性，ER被验证为治疗CMI的首选疗法。版权所有 © 2023。发表于Elsevier Inc.

Guidelines recommend open surgical (OR) over endovascular revascularization (ER) for the treatment of chronic mesenteric ischemia (CMI) for younger, healthier patients. However, little is known about the long-term costs of these recommendations with respect to patients' overall life expectancy. This study investigated whether 5-year value differs between these treatment modalities.Patient data were extracted from the Statewide Planning and Research Cooperative System, the New York statewide all-payor database containing demographics, diagnoses, treatments, and charges. The database was queried for patients with an International Classification of Diseases, Ninth Revision code for CMI, with the specific exclusion of acute ischemia cases. A propensity score match was performed using Charlson Comorbidity Index, age, sex, race, renal status, and pulmonary disease for a final cohort of patients. Multiple linear regression and mixed effects linear regression were utilized to determine factors associated with 5-year value, calculated as life years/$100k in charges. Charges were gathered from the index admission and subsequent admissions for acute or chronic mesenteric ischemia, mesenteric angiography, or follow-up reintervention. Kaplan-Meier estimation was performed for survival and reintervention-free survival.From 2000 to 2014, 875 patients underwent intervention for CMI. Of those meeting inclusion criteria, 209 (28.1%) underwent OR and 535 (71.9%) ER. After propensity score matching (n=209 each group), the ER group showed higher value at 5 years post-procedure (8.04±11.42 versus 4.89±5.28 life years/$100k charges, p<0.01). More patients underwent reintervention in the ER group (37 versus 17 patients, p<0.01), with 55 reinterventions in the ER group and 19 in the OR group (p<0.01). Multiple linear regression analysis showed that age, congestive heart failure, dysrhythmia, cancer, and days spent in the intensive care unit were negatively associated with value at 5 years, while ER was positively associated. Survival was 59.6 ± 3.76% versus 62.3% ± 3.49% at 5 years (p=0.91), and reintervention-free survival was 43.7 ± 3.86% versus 58.1 ± 3.53% (p=0.04), for ER and OR respectively.Despite increased reinterventions and lower reintervention-free survival, the value for patients with CMI was higher in those who underwent ER in the largest propensity score matched cohort to date looking at long-term value. Factors negatively associated with value were OR, age, days in intensive care, congestive heart failure, dysrhythmia, and cancer. In patients with amenable anatomy, ER is validated as the first-choice treatment for CMI based on the superior procedural value.Copyright © 2023. Published by Elsevier Inc.