Perry Brandon C, Kwan Sharon W
Department of Radiology, University of Washington, Seattle, Washington.
Department of Radiology, University of Washington, Seattle, Washington.
J Am Coll Radiol. 2015 Dec;12(12 Pt B):1427-33. doi: 10.1016/j.jacr.2015.06.037. Epub 2015 Sep 26.
The aim of this study was to assess national trends in utilization, demographics, hospital characteristics, and outcomes of patients undergoing surgical or percutaneous portal decompression since the introduction of transjugular intrahepatic portosystemic shunts (TIPS).
A retrospective analysis of patients undergoing surgical portal decompression and TIPS procedures was conducted using Medicare Physician/Supplier Procedure Summary Master Files from January 2003 through December 2013 and National (Nationwide) Inpatient Sample data from 1993, 2003, and 2012. Utilization rates normalized to the annual number of Medicare enrollees, estimated means, and 95% confidence intervals were calculated.
The Medicare total annual utilization rate per million for all portosystemic decompression procedures decreased by 6.5% during the study period, from 15.3 in 2003 to 14.3 in 2013. TIPS utilization increased by 19.4% (from 10.3 to 12.3 per million), whereas open surgical shunt utilization decreased by 60.0% (from 5.0 to 2.0 per million). TIPS procedures represented 86% of all procedures in 2013. From 1993 to 2012, mean age increased slightly (from 53.0 to 55.5 years, P < .05). The percentage of procedures performed at teaching hospitals increased, whereas in-hospital mortality and length of stay decreased by 42% (P < .05) and 20% (P < .05), respectively. Of factors evaluated, the performance of procedures on an elective basis was the most influential on in-hospital mortality (P < .01, all years studied) and length of stay (P < .0001, all years studied).
Approximately two decades after the introduction of TIPS, the utilization of all portal decompression procedures has remained relatively stable. The TIPS procedure represents the dominant portal decompression technique. In-hospital mortality and mean length of stay after decompression have decreased, partially because of the performance of procedures during elective admissions.
本研究旨在评估自经颈静脉肝内门体分流术（TIPS）引入以来，接受外科手术或经皮门体减压术患者的利用情况、人口统计学特征、医院特征及治疗结果的全国趋势。
利用2003年1月至2013年12月的医疗保险医师/供应商手术摘要主文件以及1993年、2003年和2012年的全国（全国范围）住院患者样本数据，对接受外科门体减压术和TIPS手术的患者进行回顾性分析。计算以医疗保险参保人数年数标准化的利用率、估计均值和95%置信区间。
在研究期间，所有门体减压手术的医疗保险每年每百万总利用率下降了6.5%，从2003年的15.3降至2013年的14.3。TIPS的利用率增加了19.4%（从每百万10.3增至12.3），而开放式外科分流术的利用率下降了60.0%（从每百万5.0降至2.0）。2013年，TIPS手术占所有手术的86%。从1993年到2012年，平均年龄略有增加（从53.0岁增至55.5岁，P < 0.05）。在教学医院进行的手术百分比增加，而住院死亡率和住院时间分别下降了42%（P < 0.05）和20%（P < 0.05）。在所评估的因素中，择期进行手术对住院死亡率（P < 0.01，所有研究年份）和住院时间（P < 0.0001，所有研究年份）影响最大。
TIPS引入约二十年后，所有门体减压手术的利用率一直保持相对稳定。TIPS手术是主要的门体减压技术。减压后的住院死亡率和平均住院时间有所下降，部分原因是择期入院时进行手术。
