Background: Transjugular intrahepatic portosystemic shunt (TIPS) creation is a commonly utilized procedure used for patients with chronic liver disease and resistant portal hypertension. Previous studies have explored the trends and short-term outcomes in TIPS procedures. This study aims to further compare short-term in-hospital outcomes of patients with coagulation disorders when undergoing TIPS.
Methods: This retrospective cohort study utilized data from the Nationwide Inpatient Sample (NIS) to identify adult patients (18+) from 2012-2014 who underwent a TIPS procedure. ICD-9 codes identified patients with a history of coagulation disorders. Patients missing important clinical identifiers (age, gender, death) were excluded. Patients with a diagnosis of bleeding from an ulcer in the gastrointestinal tract or from angiodysplasia were excluded as well. Data analyses assessed hospital length of stay (LOS), inpatient charges, and mortality rate.
Results: Of the 49,074 patients identified to undergo a TIPS, 2,177 patients had a diagnosis of a coagulation disorder. Patients without a coagulation disorder had a mean mortality rate of 0.5% and mean total hospital charges of $36,467.21. Total hospital charges and mortality rate for patients with a coagulation disorder were $148,183.66 (p ≤ 0.001) and 9.9% (p ≤ 0.001). LOS for patients without a coagulation disorder was a mean of 3.79 days and patients with coagulation disorder was a mean of 9.81 (p ≤ 0.001) days.
Conclusions: Patients undergoing TIPS who are pre-disposed with coagulation disorders suffer from longer LOS, increased total hospital charges and increased mortality rate. Laboratory tests to screen and diagnose liver and renal failure, systemic infection, coagulopathy and to establish a Child-Pugh classification are all done prior to TIPS as it is imperative in managing hospital stay for these patients. Optimization of treatment and management of prior diagnosed coagulation disorders can provide avenues for lowering length of stay, total charges and mortality rate. Future analysis to break down specific coagulation disorders and their effects of hospital stay can further improve the outcomes of patients undergoing TIPS to treat their chronic liver disease and treatment-resistant portal hypertension.