title: National Trends and Outcomes of Transjugular Intrahepatic Portosystemic Shunt Creation Using the Nationwide Inpatient Sample.
abstract: OBJECTIVE
  To elucidate trends in transjugular intrahepatic portosystemic shunt (TIPS) use and outcomes over the course of a decade, including predictors of inpatient mortality and extended length of hospital stay.
  
  
  METHODS
  The Nationwide Inpatient Sample was interrogated for the most recent 10 years available: 2003-2012. TIPS procedures and associated diagnoses were identified via International Classification of Diseases (version 9) codes, with the latter categorized into primary diagnoses in a hierarchy of disease severity. Linear regression analysis was used to determine trends of TIPS use and outcomes over time. Independent predictors of mortality and extended length of stay were determined by logistic regression.
  
  
  RESULTS
  A total of 55,145 TIPS procedures were captured during the study period. Annual procedural volume did not change significantly (5,979 in 2003, 5,880 in 2012). The majority of TIPSs were created for ascites and/or varices (84%). Inpatient mortality (12.5% in 2003, 10.6% in 2012; P < .05) decreased but varied considerably by diagnosis (from 3.7% to 59.3%), with a disparity between bleeding and nonbleeding varices (18.7% vs 3.8%; P < .01). Multivariate predictors of mortality (P < .001 for all) included primary diagnoses (bleeding varices, hepatorenal and abdominal compartment syndromes), patient characteristics (age > 80 y, black race), and sequelae of advanced cirrhosis (comorbid hepatocellular carcinoma, spontaneous bacterial peritonitis, encephalopathy, and coagulopathy).
  
  
  CONCLUSIONS
  National TIPS inpatient mortality has decreased since 2003 while procedural volume has not changed. Postprocedural outcome is a function of patient demographic and socioeconomic factors and associated diagnoses. Independent predictors of poor outcome identified in this large national population study may aid clinicians in better assessing preprocedural risk.
authors.affiliation: Department of Radiology, University of Colorado Denver Anschutz Medical Center, Mail Stop 8200, AO1, Room 2414, 12631 E. 17th Ave., Aurora, CO 80045. Electronic address: premalstrivedi@gmail.com.
authors.forename: Premal S
authors.initials: PS
authors.lastname: Trivedi
authors.affiliation: Department of Radiology, University of Colorado Denver Anschutz Medical Center, Mail Stop 8200, AO1, Room 2414, 12631 E. 17th Ave., Aurora, CO 80045.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rochon
authors.affiliation: Department of Radiology, University of Colorado Denver Anschutz Medical Center, Mail Stop 8200, AO1, Room 2414, 12631 E. 17th Ave., Aurora, CO 80045.
authors.forename: Janette D
authors.initials: JD
authors.lastname: Durham
authors.affiliation: Department of Radiology, University of Colorado Denver Anschutz Medical Center, Mail Stop 8200, AO1, Room 2414, 12631 E. 17th Ave., Aurora, CO 80045.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay / Q000639:trends; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States