Hospital readmission following transjugular intrahepatic portosystemic shunt: a 14-year single-center experience.

Published on Apr 1, 2020in Gastroenterology Report2.194
· DOI :10.1093/GASTRO/GOZ062
Catherine F. Vozzo (Cleveland Clinic), Tavankit Singh5
Estimated H-index: 5
(Cleveland Clinic)
+ 3 AuthorsBaljendra Kapoor10
Estimated H-index: 10
(Cleveland Clinic)
Background: Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively common procedure used to treat complications of portal hypertension. However, only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital readmission. We therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of readmission. Methods: We reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients. A series of univariable logistic-regression models were fit to assess potential predictors of 30-day readmission. Results: A total of 566 patients were included in the analysis. The 30-day readmission rate after TIPS placement was 36%. The most common causes for readmission were confusion (48%), infection (15%), bleeding (11%), and fluid overload (7%). A higher Model for End-Stage Liver Disease (MELD) score corresponded with a higher rate of readmission (odds ratio associated with each 1-unit increase in MELD score: 1.06; 95% confidence interval: 1.02-1.09; P = 0.001). Other potential predictors, including indication for TIPS placement, were not significantly associated with a higher readmission rate. Conclusions: The 30-day readmission rate after TIPS placement with covered stents is high, with nearly half of these readmissions due to hepatic encephalopathy-a known complication of TIPS placement. Novel interventions to help reduce the TIPS readmission rate should be prioritized in future research.
  • References (21)
  • Citations (1)
#1Filippo Schepis (University of Modena and Reggio Emilia)H-Index: 22
#2Francesco Vizzutti (UniFI: University of Florence)H-Index: 24
Last. Erica Villa (University of Modena and Reggio Emilia)H-Index: 34
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Background & Aims Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal ...
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#1Lindsay SobotkaH-Index: 2
#2Rohan M. ModiH-Index: 3
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#1Macarena Simón-Talero (Autonomous University of Barcelona)H-Index: 13
#2Davide Roccarina (Royal Free Hospital)H-Index: 17
Last. Enrique Ramón Botella (Hospital General Universitario Gregorio Marañón)H-Index: 1
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Abstract Background & Aims Spontaneous portosystemic shunts (SPSSs) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSSs in patients with cirrhosis and their outcomes. Methods We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015...
20 CitationsSource
#1Eric S. OrmanH-Index: 10
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Hospital readmissions in decompensated cirrhotics: Factors pointing toward a prevention strategy
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In patients with cirrhosis with refractory ascites, the 10-mm-diameter polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt, compared with the 8-mm stent, was associated with a greater reduction in portosystemic gradient and lower need for paracentesis; the 10-mm stent was not associated with higher incidence and severity of hepatic encephalopathy or other unfavorable outcomes, including procedural-related mortality.
13 CitationsSource
#1Ammar Sarwar (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 18
#2Lujia Zhou (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 2
Last. Muneeb Ahmed (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 35
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Abstract Purpose To determine all-cause readmission rates for 12 IR procedures and association of time to readmission with risk-adjusted 90-day mortality. Materials and Methods Patients discharged after 12 inpatient IR procedures at a tertiary-care hospital between June 2008 and May 2013 (N = 4,163) were categorized as no readmission (n = 1,479; 40.5%) or readmission between 0 and 7 (n = 379; 10.4%), 8 and 30 (n = 650; 17.8%), 31 and 60 (n = 378; 10.3%), 61 and 90 (n = 169; 4.6%), or 91 and 180 ...
6 CitationsSource
#1Andrew Kuei (UCLA: University of California, Los Angeles)H-Index: 2
#2Edward W. Lee (UCLA: University of California, Los Angeles)H-Index: 28
Last. Stephen T. Kee (UCLA: University of California, Los Angeles)H-Index: 42
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Background Despite widespread use of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension, a paucity of nationwide data exists on predictors of the economic impact related to TIPS.
1 CitationsSource
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The transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. The first TIPS was performed in Germany in 1988. The VIATORR self-expandable PTFE covered stent-graft (WL Gore, Flagstaff AZ) was approved by the FDA for a TIPS application in December of 2004. This stent-graft offers excellent shunt patency rates and it is possible that it has a beneficial effect on patient survival. Patient surveillance and post-procedural mana...
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#1Octavi Basssegoda (University of Barcelona)
#2Andrés Cárdenas (University of Barcelona)H-Index: 31