Abstract No. 195 National trends in transjugular intrahepatic portosystemic shunt placement, revision, and trainee procedure involvement

Abstract

To evaluate national trends in transjugular intrahepatic portosystemic shunt (TIPS) creation and revision rates and evaluate trainee exposure to TIPS placement and revision Medicare Physician/Supplier Summary Files were evaluated from 2010 to 2018. TIPS shunt creation and revision procedures were aggregated. Procedures involving a trainee were identified. The rate of TIPS placement, revision, and trainee involvement were evaluated in the context of Medicare enrollment and number of diagnostic and interventional radiology residents as well as interventional radiology fellows using Accreditation of Graduate Medical Education (ACGME) data. From 2010 to 2018, annual claims for de novo TIPS placement increased from 1,725 procedures to 1,947 procedures (+12.8%). When controlled for number of Medicare enrollees, this resulted in an increase of 4.8 to 5.0 (+4.0%) TIPS procedures per 100,000 beneficiaries. TIPS revisions increased from 645 procedures in 2010 to 932 (+45%) procedures in 2018. When controlled for Medicare enrollment, this represented an increase from 1.8 to 2.4 (+33%) TIPS revisions per 100,000 Medicare enrollees. Over time, the ratio of TIPS placements to TIPS revisions decreased from 2.7 to 2.1 (-29%), driven by a relatively higher increase of revisions compared to de novo placements. The number of TIPS placements involving a trainee increased from 17% to 26%. Similarly, the rate of trainee involvement in revisions increased from 18% to 29%. Ratio of TIPS placements and revisions per one thousand trainees increased 55% and 111%, respectively. The rate of TIPS placement and revisions continues to increase in the Medicare population, with a disproportionate increase in TIPS revisions compared to placements. Trainee involvement in these procedures has increased nationally from 2010 to 2018. Further research is needed to evaluate the disproportionate increase in TIPS revisions to placements in this population.