LYON, December 12, 2025 (APMnews) – Treatment in the first French intestinal vascular emergency (Survi) structure, set up at the Beaujon hospital (AP-HP, Clichy, Hauts-de-Seine), is associated with a very early benefit on survival, which extends over time, compared to non-specialized units of 13 university hospitals, and appears very “cost-effective”, according to the results of a study presented Friday at the Francophone Nutrition Days (JFN) in Lyon.
Inspired by the model of “stroke centers” for stroke, this eight-bed unit dedicated to the multidisciplinary management of acute mesenteric ischemia (AMI) was created in 2016 within an expert center in intestinal insufficiency at Beaujon hospital (see news report from 01/29/2016 at 6:10 p.m.). It has a 24-hour gastroenterologist who receives calls, reviews scans, confirms the diagnosis and coordinates all revascularization, digestive surgery and medical treatment.
“Mesenteric infarction of the intestine is still one of the most serious diseases today”, with 60% mortality, or even 100% without treatment, and “it is the leading cause of short bowel syndrome in France and in Europe” and therefore an important cause of parenteral nutrition, underlined Professor Alexandre Nuzzo of Beaujon hospital.
Despite mortality six times higher than that of myocardial infarction, until 2016 there was no specific intensive care unit for AMI, like the cardiological (Usic) and neurovascular (USINV) intensive care units, which have shown their clinical benefits in vascular emergencies, he added.
A first positive assessment was presented in 2023 in posters during Digestive Disease Week (DDW) (see dispatch of 05/09/2023 at 7:30 p.m.).
In the work presented Friday at the JFN, funded as part of the research program on the performance of the healthcare system (Preps), the team assessed the impact on the prognosis of patients and the cost-effectiveness of treatment in this structure.
With the help of the Ile-de-France clinical research unit in health economics (URC ECO), the researchers analyzed data from the national health data system (SNDS) between 2016 and 2022, the year when Survi was still the only specialized unit in France. Since then, a few other units have been set up, notably in Marseille and Nice, under the name “SOS ischemia”.
The study included 9,852 patients with AMI, including 1,076 treated in the Survi unit (average age of 64 years and slightly fewer comorbidities) and 8,776 in centers with a complete vascular and digestive technical platform of 13 university hospitals (average age of 68 years).
Care in the Survi unit was associated with a significantly higher probability of survival at 12 months, at 62% compared to 50%, with a risk of death (hazard ratio adjusted, HRa) reduced to 0.69. Professor Nuzzo underlined a benefit on very early survival and “which extends over time”.
The risk of intestinal resection was also significantly reduced to 31% compared to 39% in other hospitals (HRa at 0.75). Revascularization was performed twice as frequently in patients in the Survi unit compared to the university hospitals (23% compared to 12%), with a shorter median time to revascularization (five days compared to 6.2 days).
Towards new intestinal vascular emergency structures in France?
These results show that in a non-specialized center compared to the Survi unit, there was a 1.45 times higher risk of mortality and a 1.34 times higher risk of resection, underlined Professor Nuzzo.
Admission to intensive care was significantly less frequent (42% vs 53%), with a shorter median length of stay (5.9 days vs 7.2 days) for patients treated in the Survi unit.
Finally, these patients had fewer small bowel operations and required more rehabilitation surgery (13% vs 7%).
On a medico-economic level, the incremental cost-effectiveness ratio (ICER) was estimated at 33,894 euros per year of life gained, which places this strategy in the range of interventions considered very cost-effective, insisted Professor Nuzzo.
“This is the first and largest comparative study that demonstrates the prognostic impact of a specialized structure to improve survival, resection and ultimately all secondary endpoints, in acute mesenteric ischemia, with a very good cost-effectiveness ratio,” he concluded.
Furthermore, by reducing the need for intestinal resections, this model could prevent short bowel syndrome, intestinal failure and dependence on parenteral nutrition. However, the activity of the unit treating short bowel does not decrease, on the contrary, because patients who previously died can now present with this syndrome, noted the researcher. However, it is often a transient syndrome.
Professor Nuzzo hopes that these results will be used as arguments to develop new structures in France and other countries. It appears necessary to have an intestinal failure unit alongside a Survival unit.
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