S1249 Transjugular Intrahepatic Portosystemic Shunts (TIPS) Outcomes in the Elderly Population: A Systematic Review and Meta-analysis

Abstract

Introduction: Trans-jugular intrahepatic portosystemic shunt (TIPS) effectively treats ascites and variceal bleeding (VB). However, it has increased morbidity and mortality in advanced age. Therefore, our goal was to assess TIPS adverse events in the elderly population. Methods: A search strategy was developed using Embase, Cochrane library databases, and the Web of Science Core Collection. First, we separated patients into two groups: < 65-70 and > 65-70; due to a lack of data on specific outcomes, we ran a combined analysis first, then a sub-group analysis on ages < 65 vs. > 65 and < 70 vs. > 70 Results: Six Studies, which included 1591 patients, met our inclusion criteria and were included in the final meta-analysis. 1194 patients were in the group aged < 65-70 years, and 432 were in the group aged > 65-70 years. A combined analysis revealed a higher 90-day mortality rate after TIPS among patients aged > 65-70 years. Subgroup analyses demonstrated a significantly higher rate of post-TIPS hepatic encephalopathy (HE) (RR:0.42, CI: 0.185-0.953, p=0.03). Overall 30-day (RR:0.37, CI:0.188-0.74, p=0.005), and 90-day mortality (RR:0.35, CI: 0.24-0.49, p=0.001 was higher among patients aged > 70 years vs. < 70 years. Conclusion: This meta-analysis found that age is not a significant risk factor for increased 30-day all-cause readmission after TIPS. However, the elderly group aged > 70 years was significantly associated with a higher risk of post-TIPS HE. In addition, the overall 30-day and 90-day mortality were considerably higher in patients aged > 70 years than those < 70 years. Other outcomes were comparable but did not achieve statistical significance. In conclusion, TIPS in the elderly is associated with higher overall 30-day and 90-day mortality rates and increased risk for post-TIPS HE, especially in patients aged > 70 years. Though results caution against TIPS in the elderly population, it is inexpedient to draw firm conclusions at this point. Additional studies, particularly large RCTs, are warranted.