Abstract
comes, including predictors of inpatient mortality, over a decade. Materials and Methods: The National Inpatient Sample, a stratified database representing 90% of all US hospital admissions, was interrogated for the past 10 available years: 2003-2012. TIPS procedures and underlying diagnoses were identified via ICD 9 codes, the latter categorized into primary indications (PI) using a hierarchy of disease severity. Linear regression analysis was used to trend TIPS and outcomes of mortality and morbidity over time. Independent predictors of mortality, morbidity and length of stay were determined using logistic regression. Results: 55145 TIPS procedures were captured during the study period. The majority of cases were performed in high volume (79%), urban (97%), teaching (78%) hospitals. Incidence of TIPS increased significantly over time for the PIs of nonbleeding varices (p1⁄40.002), GI bleed (p1⁄40.03), hepatorenal syndrome (p1⁄40.02), and hydrothorax (p1⁄40.045), while incidence for other indications remained constant. Median age of the TIPS population was 55 years and most patients were male (65%). There was a negative correlation between the patient’s zip code income quartile and representation within the TIPS cohort (27.6% lowest income, 21.8% highest income; po0.001). Inpatient mortality (12.5% in 2003, 10.6% in 2012; po0.05) decreased over the study period. Multivariate predictors of inpatient mortality (po0.001 for all) following TIPS included diagnostic indicators (Bleeding varices, Hepatorenal and Abdominal Compartment syndromes), patient characteristics (age480 years, black race) and sequelae of advanced cirrhosis (comorbid HCC, SBP, encephalopathy and coagulopathy). Conclusion: National TIPS inpatient mortality has decreased since 2003. Complication rates vary by underlying diagnosis as well as baseline patient demographics and comorbidities. Our predictive models for post-TIPS hospital mortality and length of stay may aide clinicians in assessing pre-procedure risk.
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