SIR 2024
Portal Hypertension
Brittney Deadwiler, BA (she/her/hers)
Medical Student
Keck School of Medicine of USC
Financial relationships: Full list of relationships is listed on the CME information page.
David Hernandez, BS
Medical Student
Keck School of Medicine of University of Southern California
Disclosure information not submitted.
Delal Ghebremedhin, BS Candidate
Undergraduate Student
Keck School of Medicine of USC, Department of Radiology
Disclosure information not submitted.
Edris Saadat, BS
Medical Student
Keck School of Medicine of University of Southern California
Disclosure information not submitted.
Megan Worthington, MS
Medical Student
Touro College of Osteopathic Medicine
Disclosure information not submitted.
Xiaomeng Lei, MPH
Statistician
Keck School of Medicine, University of Southern California
Disclosure information not submitted.
Steven Cen, PhD
Professor Of Research
Keck School of Medicine, University of Southern California
Disclosure information not submitted.
Stuart Schroff, MD
Interventional Radiologist
Keck School of Medicine of USC
Disclosure information not submitted.
Ramon Ter-Oganesyan, MD
Interventional Radiologist
University of Southern California
Disclosure information not submitted.
Michael Katz, MD
Interventional Radiologist
Keck School of Medicine of USC
Disclosure information not submitted.
Jenanan Vairavamurthy, MD
Assistant Professor, Interventional Radiologist
Keck School of Medicine, Univeristy of Southern California
Disclosure information not submitted.
Transjugular intrahepatic portosystemic shunt (TIPS) is an invasive therapy for patients with variceal hemorrhage or refractory ascites. The evaluation, procedure, and follow-up are comprehensive and have high costs. This study investigates whether disparities exist in the selection and outcomes of patients undergoing TIPS between a private tertiary transplant center and a public county hospital located on the same medical campus.
Materials and Methods:
After obtaining IRB approval, all TIPS procedures done at the private and public hospitals at a single medical campus over 8 years were collected. Only cases with sufficient pre-procedural evaluation and 1-year follow-up were included. A retrospective chart review was performed comparing pre-procedural clinical measures and post-procedural outcomes.
Results:
This cohort includes 100 patients, 39 females and 61 males. Fifty cases were from each hospital. The average patient ages at the private and public hospitals were 55 and 56, respectively. The etiology of liver disease was similar between the two settings and included alcohol-related cirrhosis, viral hepatitis, NASH/NAFLD, autoimmune hepatitis, Budd-Chiari, and cryptogenic cirrhosis. TIPS indications differed significantly between hospitals (p=0.03). Indications at the public hospital included variceal bleeding (n=31, 62%), refractory ascites (n=16, 32%), hydrothorax (n=1, 2%), and portal vein thrombosis (n=2, 4%). Conversely, the private hospital primarily performed TIPS for refractory ascites (n=27, 54%), variceal bleeding (n=18, 36%), hydrothorax (n=4, 8%), and transplant eligibility (n=1, 2%). Pre-procedural MELD scores were not significantly different. Patients at the public hospital were more likely to undergo pre-TIPS endoscopy (p < 0.01) and had a higher number of pre-TIPS intensive care unit days (p = 0.04). Despite this, the private hospital exhibited higher post-TIPS ALT, AST, creatinine, and FIPS scores (p = 0.03, < 0.01, 0.05, and 0.02, respectively). There was no significant difference in mortality rates or patency between the hospitals.
Conclusion:
This study demonstrates differences in the clinical profiles between private and public hospital TIPS patients despite having the same physicians performing the procedure at both sites. Interestingly, TIPS was used more for variceal hemorrhage at the county hospital and more for refractory ascites at the private tertiary transplant center. Future analysis with a larger patient cohort may assist in further clarifying these differences.