Barrera Gutierrez Juan Carlos, Zullo Melissa, Sclair Seth, Tavri Sidhartha
Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, USA.
Methodist Digestive Institute, Methodist Health System, Dallas, USA.
Cureus. 2024 Jul 30;16(7):e65776. doi: 10.7759/cureus.65776. eCollection 2024 Jul.
To determine the relationship between clinical, procedural, hospital, and physician characteristics with the duration of the transjugular intrahepatic portosystemic shunt (TIPS) procedure.
This retrospective study included patients over 18 years of age who underwent an initial TIPS procedure between January 2005 and August 2020. Exclusion criteria were TIPS performed outside the institution and failed TIPS placement. A total of 154 records were included. Regression analyses were used to identify predictors of procedural duration.
The mean age at TIPS placement was 57 years. Seventy percent of patients were male and non-Hispanic whites (80.5%). The mean duration of the TIPS procedure was 169 minutes (SD: 78). Procedural duration was shorter when the etiology of cirrhosis was viral (mean: 144 min, SD: 84, p=0.008); the reason for TIPS was ascites (152, SD: 66, p=0.01); and the procedure did not require additional access (153 min, SD: 67, p=<.0001). The main clinical predictor of procedural duration was baseline bilirubin (Beta coefficient (β): 5.6 min, p=0.0007). In multivariable linear models, in those patients that did not require additional access, bilirubin (β: 4.9 min, p=0.005), etiology of cirrhosis, and physician experience were the main predictors of TIPS procedure duration. The effect of baseline bilirubin on procedural duration increased in the ascites group (β: 19.5 minutes, p=0.006), especially when additional access was not required.
The study demonstrates an association between baseline bilirubin, etiology of cirrhosis, and physician experience with the duration of the TIPS procedure. The mechanism underlying the positive association between baseline bilirubin and procedural time is possibly related to the degree of liver fibrosis.
确定临床、手术、医院及医生特征与经颈静脉肝内门体分流术（TIPS）手术时长之间的关系。
这项回顾性研究纳入了2005年1月至2020年8月期间接受首次TIPS手术的18岁以上患者。排除标准为在机构外进行的TIPS手术以及TIPS置入失败。共纳入154份记录。采用回归分析来确定手术时长的预测因素。
TIPS置入时的平均年龄为57岁。70%的患者为男性，非西班牙裔白人占80.5%。TIPS手术的平均时长为169分钟（标准差：78）。当肝硬化病因是病毒性时，手术时长较短（平均：144分钟，标准差：84，p = 0.008）；TIPS的原因是腹水时（152分钟，标准差：66，p = 0.01）；且手术不需要额外通路时（153分钟，标准差：67，p < 0.0001）。手术时长的主要临床预测因素是基线胆红素（β系数：5.6分钟，p = 0.0007）。在多变量线性模型中，对于那些不需要额外通路的患者，胆红素（β：4.9分钟，p = 0.005）、肝硬化病因和医生经验是TIPS手术时长的主要预测因素。在腹水组中，基线胆红素对手术时长的影响增加（β：19.5分钟，p = 0.006），尤其是在不需要额外通路时。
该研究表明基线胆红素、肝硬化病因和医生经验与TIPS手术时长之间存在关联。基线胆红素与手术时间呈正相关的潜在机制可能与肝纤维化程度有关。
