Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery
Abstract Background In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outc...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-023-00498-4 |
| _version_ | 1797841123056549888 |
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| author | Ramiro Manzano-Nunez Alba Jimenez-Masip Julian Chica-Yanten Abdelaziz Ibn-Abdelouahab Massimo Sartelli Nicola de’Angelis Ernest E. Moore Alberto F. García |
| author_facet | Ramiro Manzano-Nunez Alba Jimenez-Masip Julian Chica-Yanten Abdelaziz Ibn-Abdelouahab Massimo Sartelli Nicola de’Angelis Ernest E. Moore Alberto F. García |
| author_sort | Ramiro Manzano-Nunez |
| collection | DOAJ |
| description | Abstract Background In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery. Methods MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic). Results Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22–0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33–1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28–2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35–2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15–6.8, I2 = 78.9%). Conclusions Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results. |
| first_indexed | 2024-04-09T16:25:54Z |
| format | Article |
| id | doaj.art-0ab552c7917c4d1084a055c9fbfae17e |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-09T16:25:54Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-0ab552c7917c4d1084a055c9fbfae17e2023-04-23T11:12:23ZengBMCWorld Journal of Emergency Surgery1749-79222023-04-0118111810.1186/s13017-023-00498-4Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgeryRamiro Manzano-Nunez0Alba Jimenez-Masip1Julian Chica-Yanten2Abdelaziz Ibn-Abdelouahab3Massimo Sartelli4Nicola de’Angelis5Ernest E. Moore6Alberto F. García7Universitat Autònoma de BarcelonaVall d’Hebron University HospitalDepartment of Surgery, Universidad JaverianaMohammed V UniversityDepartment of Surgery, Macerata HospitalColorectal and Digestive Surgery Unit, Beaujon HospitalErnest E. Moore Shock Trauma Center and University of ColoradoDepartment of Surgery, Fundacion Valle del LiliAbstract Background In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery. Methods MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic). Results Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22–0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33–1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28–2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35–2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15–6.8, I2 = 78.9%). Conclusions Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results.https://doi.org/10.1186/s13017-023-00498-4Liver cirrhosisPortal hypertensionTransjugular intrahepatic portosystemic shuntGeneral surgeryAbdominal surgeryOutcomes |
| spellingShingle | Ramiro Manzano-Nunez Alba Jimenez-Masip Julian Chica-Yanten Abdelaziz Ibn-Abdelouahab Massimo Sartelli Nicola de’Angelis Ernest E. Moore Alberto F. García Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery World Journal of Emergency Surgery Liver cirrhosis Portal hypertension Transjugular intrahepatic portosystemic shunt General surgery Abdominal surgery Outcomes |
| title | Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery |
| title_full | Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery |
| title_fullStr | Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery |
| title_full_unstemmed | Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery |
| title_short | Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery |
| title_sort | unlocking the potential of tips placement as a bridge to elective and emergency surgery in cirrhotic patients a meta analysis and future directions for endovascular resuscitation in acute care surgery |
| topic | Liver cirrhosis Portal hypertension Transjugular intrahepatic portosystemic shunt General surgery Abdominal surgery Outcomes |
| url | https://doi.org/10.1186/s13017-023-00498-4 |
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