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

Abstract 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.

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Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.243.yao ◽

2015 ◽

Vol 24 (3) ◽

pp. 301-307 ◽

Cited By ~ 8

Author(s):

Jiannan Yao ◽

Li Zuo ◽

Guangyu An ◽

Zhendong Yue ◽

Hongwei Zhao ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Portal Hypertension ◽

Hepatic Encephalopathy ◽

Pressure Gradient ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Meld Score ◽

Portosystemic Shunt ◽

Portal Flow ◽

Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words: – – – .

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MELD Score Less Than 15 Predicts Prolonged Survival After Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites After Liver Transplantation

Transplantation Journal ◽

10.1097/tp.0b013e31820e014e ◽

2011 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Eyob Feyssa ◽

Jorge Ortiz ◽

Kevin Grewal ◽

Ashaur Azhar ◽

Afshin Parsikia ◽

...

Keyword(s):

Liver Transplantation ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Meld Score ◽

Portosystemic Shunt ◽

Prolonged Survival ◽

Refractory Ascites ◽

Intrahepatic Portosystemic Shunt

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High MELD Score Has No Effect On the Magnitude of the Mortality Increase Observed With Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement.

Transplantation Journal ◽

10.1097/00007890-201407151-00495 ◽

2014 ◽

Vol 98 ◽

pp. 163

Author(s):

E. Spengler ◽

S. Zarei ◽

B. Zimmerman ◽

L. Hunsicker ◽

M. Voigt

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Meld Score ◽

Portosystemic Shunt ◽

Mortality Increase ◽

Intrahepatic Portosystemic Shunt

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191 CLINICAL EFFICACY OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT CREATED WITH COVERED STENTS WITH DIFFERENT DIAMETERS: RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Journal of Hepatology ◽

10.1016/s0168-8278(10)60193-6 ◽

2010 ◽

Vol 52 ◽

pp. S82-S83 ◽

Cited By ~ 1

Author(s):

O. Riggio ◽

L. Ridola ◽

S. Angeloni ◽

F. Cerini ◽

F. Fanelli ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Clinical Efficacy ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Controlled Trial ◽

Portosystemic Shunt ◽

Covered Stents ◽

Randomized Controlled ◽

Intrahepatic Portosystemic Shunt ◽

Different Diameters

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Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

BioMed Research International ◽

10.1155/2016/3681731 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Fuliang He ◽

Shan Dai ◽

Zhibo Xiao ◽

Lei Wang ◽

Zhendong Yue ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Portal Vein ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Vena Cava ◽

Multivariate Logistic Regression Analysis ◽

Meld Score ◽

Portosystemic Shunt ◽

Pathological Features ◽

Intrahepatic Portosystemic Shunt ◽

Artificial Channel

Background. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE); previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466–5.592; P=0.002), HE comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P<0.001), or higher MELD score (95% CI, 1.298–1.731; P<0.001). Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P<0.001), higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355–4.359; P=0.003), and higher MELD score (95% CI, 1.711–2.406; P<0.001). Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.

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Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Digestive Diseases ◽

10.1159/000486030 ◽

2018 ◽

Vol 36 (3) ◽

pp. 218-227 ◽

Cited By ~ 4

Author(s):

Matthias Buechter ◽

Paul Manka ◽

Guido Gerken ◽

Ali Canbay ◽

Sandra Blomeyer ◽

...

Keyword(s):

Portal Hypertension ◽

Liver Disease ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Venous Pressure ◽

Portosystemic Shunt ◽

Refractory Ascites ◽

Control Group ◽

Covered Stents ◽

Group I ◽

Intrahepatic Portosystemic Shunt

Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. Patients and Methods: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. Results: Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist’s experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased patency.

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