Brandon C Perry1, Sharon W Kwan2. 1. Department of Radiology, University of Washington, Seattle, Washington. 2. Department of Radiology, University of Washington, Seattle, Washington. Electronic address: shakwan@u.washington.edu.
Abstract
PURPOSE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
PURPOSE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Emmanuel E Zervos; Dana Osborne; Steven C Agle; Micheal M McNally; Brian Boe; Alexander S Rosemurgy Journal: Am Surg Date: 2010-03 Impact factor: 0.688
Authors: Whalen Clark; Jonathan Hernandez; Brianne McKeon; Desiree Villadolid; Sam Al-Saadi; John Mullinax; Sharona B Ross; Alexander S Rosemurgy Journal: Am Surg Date: 2010-08 Impact factor: 0.688
Authors: Teviah E Sachs; Aslam Ejaz; Matthew Weiss; Gaya Spolverato; Nita Ahuja; Martin A Makary; Christopher L Wolfgang; Kenzo Hirose; Timothy M Pawlik Journal: Surgery Date: 2014-03-15 Impact factor: 3.982
Authors: Jean Marc Perarnau; Amélie Le Gouge; Charlotte Nicolas; Louis d'Alteroche; Patrick Borentain; Faouzi Saliba; Anne Minello; Rodolphe Anty; Carine Chagneau-Derrode; Pierre Henri Bernard; Armand Abergel; Isabelle Ollivier-Hourmand; Jérome Gournay; Jean Ayoub; Christophe Gaborit; Emmanuel Rusch; Bruno Giraudeau Journal: J Hepatol Date: 2014-01-27 Impact factor: 25.083