Department of Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia, USA.
Department of Medicine, Maimonides Medical Center, New York, New York, USA.
J Gastroenterol Hepatol. 2021 Mar;36(3):775-781. doi: 10.1111/jgh.15194. Epub 2020 Sep 8.
Nationwide data on readmissions after the transjugular intrahepatic portosystemic shunt (TIPS) procedure are lacking. We aimed to investigate the 30-day readmission rate after TIPS procedure, reasons, and predictors for readmissions and its impact on resource utilization and mortality in the USA.
We identified all adults who underwent an inpatient TIPS procedure between 2010 and 2014 using the National Readmission Database. Outcomes included all-cause 30-day readmission rate, reasons and predictors of readmissions, mortality rate, and mean hospitalization charges.
Out of a total of 31 230 hospitalizations with TIPS procedure, 28 021 patients met the study criteria and were finally included. The mean age of patients was 56.90 years, and 63.84% were men. All-cause 30-day readmission rate was 27.81%. Hepatic encephalopathy with or without coma was the most common reason for readmissions in at least 36.43% patients. The in-hospital mortality for index hospitalization and 30-day readmission was 10.69% and 5.85%, respectively. The mean hospitalization charges for index hospitalization and readmissions were $153 357 and $45 751, respectively. Advanced age, Medicaid insurance, higher Charlson comorbidy index, ascites as indication of TIPS, and nonspecific or hepatitis C cirrhosis etiologies for cirrhosis were found to be independent predictors of 30-day readmissions after a TIPS procedure.
Our study found a high rate of readmission for patients undergoing TIPS procedure, and the majority of these readmissions were related to hepatic encephalopathy. Further studies highlighting areas for improvement, particularly for patient selection and post-discharge care, are needed to reduce readmissions.
目前缺乏关于经颈静脉肝内门体分流术（TIPS）后再入院的全国性数据。本研究旨在调查美国 TIPS 术后 30 天再入院率、再入院的原因和预测因素，及其对资源利用和死亡率的影响。
我们使用国家再入院数据库，确定了 2010 年至 2014 年间所有接受住院 TIPS 治疗的成年人。主要结局为全因 30 天再入院率、再入院的原因和预测因素、死亡率以及平均住院费用。
在总共 31230 例 TIPS 治疗的住院患者中，有 28021 例符合研究标准，最终被纳入研究。患者的平均年龄为 56.90 岁，63.84%为男性。全因 30 天再入院率为 27.81%。肝性脑病伴或不伴昏迷是至少 36.43%患者再入院的最常见原因。指数住院期间和 30 天再入院的院内死亡率分别为 10.69%和 5.85%。指数住院和再入院的平均住院费用分别为 153357 美元和 45751 美元。高龄、医疗补助保险、较高的 Charlson 合并症指数、腹水作为 TIPS 适应证以及非特异性或丙型肝炎肝硬化病因被发现是 TIPS 术后 30 天再入院的独立预测因素。
我们的研究发现，接受 TIPS 治疗的患者再入院率较高，其中大多数再入院与肝性脑病有关。需要进一步研究以确定需要改进的领域，特别是在患者选择和出院后护理方面，以降低再入院率。
