SIR 2024
Portal Hypertension
Mohamed Aldallal, BS
Medical Student
Indiana University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Waseem Wahood, MD, MS
Resident
HCA Aventura Hospital; University of Miami
Financial relationships: Full list of relationships is listed on the CME information page.
To identify the variables associated with TIPS procedures performed using intravascular ultrasound (IVUS) compared to fluoroscopy alone and evaluate the difference in admission costs for the two techniques.
Materials and Methods:
The 2016-2020 HCUP - National Inpatient Sample (NIS) database was queried for the most common indications of TIPS procedures. The main outcome variable of interest was the type of modality utilized. A multivariable hierarchical logistic regression was performed to assess the variables associated with the use of IVUS compared to fluoroscopy alone. Additionally, an inverse propensity weighted with regression adjustment (IPWRA) analysis was conducted to assess the association of the two procedural techniques to Discharge Other than Home (DOTH) and cost of admission.
Results:
A total of 30,605 patients met the inclusion criteria, of which 30,325 (99.1%) underwent TIPS using fluoroscopy only and 280 (0.9%) underwent the procedure using IVUS. Multivariable regression analysis revealed that age was not associated with the use of IVUS (Odds ratio [OR]: 1.01; 95% confidence interval [CI]: 0.98-1.03; p = 0.56). Black or African American race was associated with similar odds of utilizing IVUS compared to the white race (OR: 0.77; 95% CI: 0.11-5.43; p = 0.79), while the Hispanic race was associated with higher odds (OR: 2.04; 95% CI: 1.03-4.02; p = 0.04). Compared to hospitals in the West, hospitals in the South were associated with similar odds of performing TIPS with IVUS, while hospitals in the Midwest and West were associated with higher odds of utilizing IVUS, (OR: 2.14; 95% CI: 0.64-7.14; p = 0.22) and (OR: 4.65; 95% CI: 1.45-14.91; p = 0.01), respectively. Compared to rural hospitals, urban non-teaching hospitals were associated with lower odds of undergoing IVUS (OR: 0.253; 95% CI: 0.03-2.41; p = 0.23), while urban teaching hospitals were associated with higher odds of utilizing IVUS (OR: 0.29; 95% CI: 0.03-2.38; p = 0.25). IPWRA analysis revealed that the total cost of admission was similar for those who underwent TIPS with IVUS compared to those who underwent fluoroscopy alone by -13.22% on average (95% CI: -38.10%-11.65%; p = 0.30). The rate of DOTH was lower for those who underwent IVUS compared to fluoroscopy alone by -13.68% on average (95% CI: -21.52% to -5.85%; p = 0.001).
Conclusion:
While the majority of TIPS procedures are performed without IVUS, the results illustrate comparable hospital admission costs, which may support it’s elective use. Additionally, the findings indicate a higher prevalence of IVUS usage in academic centers.