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Abstract Details
Causes and Rates of 30-Day Readmissions After Transjugular Intrahepatic Portosystemic Shunts
AJR Am J Roentgenol. 2020 May 6;1-7. doi: 10.2214/AJR.19.21732. Online ahead of print.
Ammar Sarwar12, Jeffrey L Weinstein1, Victor Novack23, Nihara Chakrala1, Elliot B Tapper23, Raza Malik4, Muneeb Ahmed1
Author information
1Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, WCC 308, Boston, MA 02215.
2Center for Healthcare Delivery Sciences, Beth Israel Deaconess Medical Center, Boston, MA.
3Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.
4Department of Medicine, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE. The purpose of this study was to investigate the causes and rates of 30-day readmission after transjugular intrahepatic portosystemic shunt (TIPS) at a single liver transplant center. MATERIALS AND METHODS. We reviewed 165 TIPS procedures performed between 2003 and 2013. After excluding patients who died during the index admission (n = 16), any readmission within 30 days of discharge was identified, and cause of readmission was determined. Causes were categorized as planned or unplanned and interventional radiology (IR)-related or IR-unrelated. Unplanned readmissions were independently categorized as preventable or unpreventable by two interventional radiologists. Discrepant opinions were resolved by consensus. Factors predictive of 30-day readmission were identified by univariate and multivariate analysis. RESULTS. The reviewed TIPS procedures were performed in 165 patients (mean age ± SD, 56 ± 11 years; 69% male, 31% female). TIPS were placed for ascites or hydrothorax in 82 patients (50%) and variceal bleeding in 83 patients (50%). The 30-day readmission rate was 21% (31/149). The most common causes for readmissions were ascites or hydrothorax (23%, 7/31) and hepatic encephalopathy (23%, 7/31). All 30-day readmissions were unplanned; 17 (55%) of them were potentially preventable. Of the 17 potentially preventable readmissions, five (29%) were IR-related and 12 (71%) were IR-unrelated. In IR-related readmissions, all patients presented with a recurrence of symptoms (rebleeding or ascites) and were found to have TIPS stenosis or occlusion. Mortality rates were similar between patients who were and were not readmitted (p = 0.23). On multivariate analysis, spontaneous bacterial peritonitis during the index admission was the only variable associated with 30-day readmission (odds ratio = 4.81, p = 0.02). CONCLUSION. Over half of 30-day readmissions after TIPS could have been prevented by early outpatient follow-up and intraprocedural technique to optimize stent landing zones.