title: Inpatient Cost Assessment of Transjugular Intrahepatic Portosystemic Shunt in the USA from 2001 to 2012.
abstract: 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.
  
  
  
  Using the National Inpatient Sample (NIS) database from 2001 to 2012, we aimed to evaluate factors contributing to hospital cost of patients admitted to US hospitals for TIPS.
  
  
  
  Using the NIS, we identified a discharge-weighted national estimate of 61,004 TIPS procedures from 2001 to 2012. Through independent sample analysis, we determined profile factors related to increases in hospital costs.
  
  
  
  Of all TIPS cases, the mean charge adjusted for inflation to the year 2012 is $125,044 ± $160,115. The mean hospital cost adjusted for inflation is $44,901 ± $54,565. Comparing pre- and post-2005, mean charges and cost have increased considerably ($98,154 vs. $142,652, p < 0.001 and $41,656 vs. $46,453, p < 0.001, respectively). Patients transferred from a different hospital, weekend admissions, Asian/Pacific Islander patients, and hospitals in the Northeastern and Western region had higher cost. Number of diagnoses and number of procedures show positive correlations with hospital cost, with number of procedures exhibiting stronger relationships (Pearson 0.613). Comorbidity measures with highest increases in cost were pulmonary circulation disorders ($32,157 increase, p < 0.001).
  
  
  
  The cost of the TIPS procedure is gradually rising for hospitals. Alongside recent healthcare reform through the Affordable Care Act, measures to reduce the economic burden of TIPS are of increasing importance. Data from this study are intended to aid physicians and hospitals in identifying improvements that could reduce hospital costs.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kuei
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA. EdwardLee@mednet.ucla.edu.
authors.forename: Edward Wolfgang
authors.initials: EW
authors.lastname: Lee
authors.affiliation: Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Division of Liver and Pancreas Transplantation, Department of Surgery, Dumont-UCLA Transplant Center, Pfleger Liver Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.affiliation: Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Durazo
authors.affiliation: Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Steven-Huy
authors.initials: SH
authors.lastname: Han
authors.affiliation: Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: ElKabany
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA.
authors.forename: Justin P
authors.initials: JP
authors.lastname: McWilliams
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Kee
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004630:Emergencies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D006975:Hypertension, Portal / Q000191:economics / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D009511:New England / Q000453:epidemiology; D019601:Pacific States / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000191:economics*; D011652:Pulmonary Circulation; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cost; HCUP; Inpatient; NIS; TIPS; Transjugular intrahepatic portosystemic shunt; USA