Recent National Trends in Utilization and Outcomes of Transjugular Intrahepatic Portosystemic Shunt Creation

Wednesday, March 8, 2023

3:00 PM – 3:09 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Mira Malavia, BA (she/her/hers)

Medical Student
University of Missouri-Kansas City School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Premal Trivedi, MD

Assistant Professor of Radiology
University of Colorado School of Medicine
Leigh Casadaban, MD, MS

Assistant Professor
University of Colorado
JL

Jonathan Lindquist, MD (he/him/his)

Assistant Professor
Department of Radiology, University of Colorado Anschutz Medical Center
LW

Lei Wang, MSPH

Statistician
University of Colorado Health System

Disclosure(s):

Mira Malavia, BA: No financial relationships to disclose

Premal Trivedi, MD: Fortec: Consultant (Ongoing), Speaking and Teaching (Ongoing); Pneumonix: Board Membership (Ongoing)

Leigh Casadaban, MD, MS: No financial relationships to disclose

Purpose: To examine recent trends in national utilization and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials and Methods: The National Inpatient Sample, the largest capture of hospitalizations in the United States, was queried across the most recently available study years 2012-2018. TIPS creation and primary diagnoses were identified using International Classification of Diseases (versions 9 and 10) codes. Patient sociodemographics, hospital characteristics, and mortality were extracted from the database. Utilization over time and by indication was assessed using linear regression. Categorical variables were examined using chi-square analysis.

Results: TIPS creation did not change in annual volume: 30845 overall, 4805 in 2012 vs. 5080 in 2018. Fewer Black patients underwent TIPS over time (280, 6.2% in 2012 vs. 170, 3.4% in 2018; p< 0.05). Most TIPS were created at urban teaching hospitals, the relative proportion of which increased from 81% in 2012 to 90% in 2018 (p < 0.001). Ascites was the most common indication (18115, 59% overall), the proportional prevalence of which increased over the study period (53% in 2012 vs. 63% in 2018). Variceal bleeding was the second most common indication (9030, 29% overall) and its prevalence did not change over time (31% in 2012 vs. 32% in 2018). However, a greater proportion underwent TIPS in planned fashion for non-bleeding varices (20% in 2012 vs. 27% in 2018; p< 0.001). TIPS for portal vein thrombosis also slightly increased over time (480, 10% in 2012 vs. 685, 13% in 2018; p< 0.001). Inpatient mortality did not change over time (9.6% in 2012 vs. 7.0% in 2018; p=0.50), was highest for variceal bleeding (15%) and lowest for the elective non-bleeding subset (3.3%).

Conclusion: Annual volume of TIPS creation remains stable, with ascites and variceal bleeding being the most common indications. A greater proportion of TIPS for variceal bleeding are occurring in planned fashion for non-bleeding varices, for which hospital mortality is significantly lower than those with bleeding varices. Urban teaching hospitals provide the vast majority of TIPS creation, the use of which is seen with lowering frequency at urban non-teaching and rural hospitals over time, decreasing access for patients in lower density census locations.