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. 2016 Jul 7;22(25):5780-9.
doi: 10.3748/wjg.v22.i25.5780.

Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

Edward Wolfgang Lee  1 , Andrew Kuei  1 , Sammy Saab  1 , Ronald W Busuttil  1 , Francisco Durazo  1 , Steven-Huy Han  1 , Mohamed M El-Kabany  1 , Justin P McWilliams  1 , Stephen T Kee  1
Affiliations

Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

Edward Wolfgang Lee et al. World J Gastroenterol. .

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

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Figures

Figure 1
Figure 1
Case selection flow. TIPS: Transjugular intrahepatic portosystemic shunt; NIS: National Inpatient Sample; ICD: International classification of diseases.
Figure 2
Figure 2
Transjugular intrahepatic portosystemic shunt trends (A) and in-hospital mortality data (B).
Figure 3
Figure 3
Odds of in-hospital death vs age 50-59.
Figure 4
Figure 4
Agency for Healthcare Research and Quality comorbidity predictors of in-hospital mortality.
See this image and copyright information in PMC

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