Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5780-5789
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5780
Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt
Edward Wolfgang Lee, Andrew Kuei, Sammy Saab, Ronald W Busuttil, Francisco Durazo, Steven-Huy Han, Mohamed M El-Kabany, Justin P McWilliams, Stephen T Kee
Edward Wolfgang Lee, Andrew Kuei, Justin P McWilliams, Stephen T Kee, Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Sammy Saab, Francisco Durazo, Steven-Huy Han, Mohamed M El-Kabany, Department of Medicine, Division of Hepatology, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA 90095, United States
Ronald W Busuttil, Dumont-UCLA Transplant Center, Pfleger Liver Institute, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, United States
Author contributions: Lee EW, Kuei A, Saab S, Busuttil RW, Durazo F, Han SH, El-Kabany MM, McWilliams JP and Kee ST equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: As this study used a national database with only deidentified patient and hospital data, this study meets the “Exempt” criteria by the Institutional Board Review.
Conflict-of-interest statement: No financial conflict-of-interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edward W Lee, MD, PhD, Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, United States. edwardlee@mednet.ucla.edu
Telephone: +1-310-2678771 Fax: +1-310-2061294
Received: March 14, 2016
Peer-review started: March 15, 2016
First decision: March 31, 2016
Revised: April 21, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: July 7, 2016
Processing time: 112 Days and 5.8 Hours
Abstract

AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 years.

METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality.

RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients (OR = 1.347 vs non-transferred, P < 0.001), emergency admissions (OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region (OR = 1.449 vs West, P < 0.001) had significantly higher odds of in-hospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death (OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure (OR = 8.246), acute kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842).

CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay has remained relatively constant. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of TIPS in-hospital death.

Keywords: Transjugular intrahepatic portosystemic shunt; Mortality; Inpatient; United States; National Inpatient Sample database; Health Cost and Utilization Project

Core tip: This is the first large-scale, national trends data investigating in-patient death following transjugular intrahepatic portosystemic shunt (TIPS) using the National Inpatient Sample database from 1998 to 2012. Over 80000 TIPS related data have been investigated. Overall in-patient mortality has been down-trending over the past 15 years. A significant decrease of mortality occurred after 2005 with an introduction of covered stent graft for TIPS which improved the patient survival and TIPS outcomes. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of in-hospital death after TIPS.