Hospital readmission following transjugular intrahepatic portosystemic shunt: a 14-year single-center experience

Background

Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively common procedure used to treat complications of portal hypertension. However, only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital readmission. We therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of readmission.

Methods

We reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients. A series of univariable logistic-regression models were fit to assess potential predictors of 30-day readmission.

Results

A total of 566 patients were included in the analysis. The 30-day readmission rate after TIPS placement was 36%. The most common causes for readmission were confusion (48%), infection (15%), bleeding (11%), and fluid overload (7%). A higher Model for End-Stage Liver Disease (MELD) score corresponded with a higher rate of readmission (odds ratio associated with each 1-unit increase in MELD score: 1.06; 95% confidence interval: 1.02–1.09; P = 0.001). Other potential predictors, including indication for TIPS placement, were not significantly associated with a higher readmission rate.

Conclusions

The 30-day readmission rate after TIPS placement with covered stents is high, with nearly half of these readmissions due to hepatic encephalopathy—a known complication of TIPS placement. Novel interventions to help reduce the TIPS readmission rate should be prioritized in future research.

Nonvascular and portal vein applications of cone-beam computed tomography: current status

C-arm cone-beam computed tomography (CBCT) is a relatively new imaging technology that uses a conical-shaped radiation beam and a 2-dimensional flat-panel detector to produce 3-dimensional volumetric datasets with excellent spatial resolution. Recently, this technology has been implemented in angiographic units across the country. This imaging modality is particularly useful when both images of "CT-like" quality and real-time fluoroscopic imaging are required for pretreatment planning and intraprocedural guidance. In this article, we describe the use of cone-beam CT technology in various nonvascular and portal venous interventions, including percutaneous vertebroplasty or kyphoplasty, transjugular intrahepatic portosystemic shunt, percutaneous needle biopsy and ablation of pulmonary nodules and renal masses, gastrostomy tube insertion, hepatic radiofrequency ablation, and biliary interventions.