Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5780
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
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.
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.