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Pizanias M, Kontis E, Prassas E, Srinivasan P, Prachalias A. Surgical portosystemic shunts to facilitate major intrabdominal surgery. Hepatobiliary Pancreat Dis Int 2019; 18:488-490. [PMID: 31151806 DOI: 10.1016/j.hbpd.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/20/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Michail Pizanias
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital NHS FT, Institute of Liver Studies, Denmark Hill, London SE5 9RS, UK.
| | - Elissaios Kontis
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital NHS FT, Institute of Liver Studies, Denmark Hill, London SE5 9RS, UK
| | - Evangelos Prassas
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital NHS FT, Institute of Liver Studies, Denmark Hill, London SE5 9RS, UK
| | - Parthi Srinivasan
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital NHS FT, Institute of Liver Studies, Denmark Hill, London SE5 9RS, UK
| | - Andreas Prachalias
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital NHS FT, Institute of Liver Studies, Denmark Hill, London SE5 9RS, UK
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Kuei A, Lee EW, Saab S, Busuttil RW, Durazo F, Han SH, ElKabany M, McWilliams JP, Kee ST. Inpatient Cost Assessment of Transjugular Intrahepatic Portosystemic Shunt in the USA from 2001 to 2012. Dig Dis Sci 2016; 61:2838-2846. [PMID: 27349987 DOI: 10.1007/s10620-016-4233-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite widespread use of transjugular intrahepatic portosystemic shunt (TIPS) for treatment of portal hypertension, a paucity of nationwide data exists on predictors of the economic impact related to TIPS. AIMS Using the National Inpatient Sample (NIS) database from 2001 to 2012, we aimed to evaluate factors contributing to hospital cost of patients admitted to US hospitals for TIPS. METHODS Using the NIS, we identified a discharge-weighted national estimate of 61,004 TIPS procedures from 2001 to 2012. Through independent sample analysis, we determined profile factors related to increases in hospital costs. RESULTS Of all TIPS cases, the mean charge adjusted for inflation to the year 2012 is $125,044 ± $160,115. The mean hospital cost adjusted for inflation is $44,901 ± $54,565. Comparing pre- and post-2005, mean charges and cost have increased considerably ($98,154 vs. $142,652, p < 0.001 and $41,656 vs. $46,453, p < 0.001, respectively). Patients transferred from a different hospital, weekend admissions, Asian/Pacific Islander patients, and hospitals in the Northeastern and Western region had higher cost. Number of diagnoses and number of procedures show positive correlations with hospital cost, with number of procedures exhibiting stronger relationships (Pearson 0.613). Comorbidity measures with highest increases in cost were pulmonary circulation disorders ($32,157 increase, p < 0.001). CONCLUSION The cost of the TIPS procedure is gradually rising for hospitals. Alongside recent healthcare reform through the Affordable Care Act, measures to reduce the economic burden of TIPS are of increasing importance. Data from this study are intended to aid physicians and hospitals in identifying improvements that could reduce hospital costs.
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Affiliation(s)
- Andrew Kuei
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA.
| | - Sammy Saab
- Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ronald W Busuttil
- Division of Liver and Pancreas Transplantation, Department of Surgery, Dumont-UCLA Transplant Center, Pfleger Liver Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Francisco Durazo
- Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Steven-Huy Han
- Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mohamed ElKabany
- Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA
| | - Stephen T Kee
- Division of Interventional Radiology, Department of Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-743730, USA
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Introduction to Cost Analysis in IR: Challenges and Opportunities. J Vasc Interv Radiol 2016; 27:539-545.e1. [PMID: 26922978 DOI: 10.1016/j.jvir.2015.12.754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Demonstration of value has become increasingly important in the current health care system. This review summarizes four of the most commonly used cost analysis methods relevant to IR that could be adopted to demonstrate the value of IR interventions: the cost minimization study, cost-effectiveness assessment, cost-utility analysis, and cost-benefit analysis. In addition, the issues of true cost versus hospital charges, modeling in cost studies, and sensitivity analysis are discussed.
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Huang L, Yu QS, Zhang Q, Liu JD, Wang Z. Transjugular intrahepatic portosystemic shunt versus surgical shunting in the management of portal hypertension. Chin Med J (Engl) 2015; 128:826-34. [PMID: 25758281 PMCID: PMC4833991 DOI: 10.4103/0366-6999.152676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension. Methods: All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges. Results: The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] = 7.45, 95% confidence interval[CI]: (3.93–14.15), P < 0.00001), the same outcomes were seen in shunt stenosis (OR = 20.01, 95% CI: (6.67–59.99), P < 0.000001) and in hepatic encephalopathy (OR = 2.50, 95% CI: (1.63–3.84), P < 0.0001). Significantly better 2-year survival (OR = 0.66; 95% CI: (0.44–0.98), P = 0.04) and 5-year survival (OR = 0.44; 95% CI: (0.30–0.66), P < 0.00001) were seen in patients undergoing surgical shunting compared with TIPS. Conclusions: Compared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS.
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Affiliation(s)
- Long Huang
- Department of No. 1 Surgery, Anhui Chinese Medical Research Institute of Surgery, The First Hospital Affiliated to Anhui Chinese Medical University, Hefei, Anhui 230031, China
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Abstract
Portosystemic shunt surgery in addition to transjugular intrahepatic portosystemic shunt (TIPS) insertion must still be regarded as a current treatment option for portomesenteric decompression in patients with pharmacological and endoscopic treatment failure, where liver transplantation is not imminent. This applies to secondary prophylaxis of rebleeding from varices in patients with well preserved liver function, e.g. liver cirrhosis CHILD A or extrahepatic portal vein thrombosis. Even if emergency endoscopy represents the treatment of choice in the acute bleeding situation, latest data from San Diego on emergency portacaval shunt surgery are encouraging. Likewise, portacaval shunt procedures can be an attractive alternative to TIPS or liver transplantation for acute Budd-Chiari syndrome or veno-occlusive disease.This article is an update on the systematics and methodology of portacaval shunt surgery, emphasizing the significance of this treatment option based on latest studies.
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