High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States
Current clinical guidelines by both American Association for the Study of Liver Disease and European Association for the Study of the Liver recommend endoscopy in all patients admitted with acute variceal bleeding within 12 hours of admission. Transjugular intrahepatic portosystemic shunt (TIPS) cre...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2021-10-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1756 |
| _version_ | 1797934914830598144 |
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| author | Premal S. Trivedi Alexandria M. Jensen Matthew A. Brown Rustain L. Morgan Richard C. Lindrooth Robert K. Ryu P. Michael Ho Michael S. Kriss |
| author_facet | Premal S. Trivedi Alexandria M. Jensen Matthew A. Brown Rustain L. Morgan Richard C. Lindrooth Robert K. Ryu P. Michael Ho Michael S. Kriss |
| author_sort | Premal S. Trivedi |
| collection | DOAJ |
| description | Current clinical guidelines by both American Association for the Study of Liver Disease and European Association for the Study of the Liver recommend endoscopy in all patients admitted with acute variceal bleeding within 12 hours of admission. Transjugular intrahepatic portosystemic shunt (TIPS) creation may be considered in patients at high risk if hemorrhage cannot be controlled endoscopically. We conducted a cross‐sectional observational study to assess how frequently TIPS is created for acute variceal bleeding in the United States without preceding endoscopy. Adult patients undergoing TIPS creation for acute variceal bleeding in the United States (n = 6,297) were identified in the last 10 available years (2007‐2016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between endoscopy nonutilization and hospital characteristics, controlling for patient demographics, income level, insurance type, and disease severity. Of 6,297 discharges following TIPS creation for acute variceal bleeding in the United States, 31% (n = 1,924) did not receive first‐line endoscopy during the same encounter. Rates of “no endoscopy” decreased with increasing population density of the hospital county (nonmicropolitan counties 43%, n = 114; mid‐size metropolitan county 35%, n = 513; and central county with >1 million population 23%, n = 527) but not by hospital teaching status (n = 1,465, 32% teaching vs. n = 430, 26% nonteaching; P = 0.10). Higher disease mortality risk (odds ratio, 0.42; 95% confidence interval, 0.22‐0.80; P = 0.02) was associated with lower odds of noncompliance. Conclusion: One third of all patients undergoing TIPS creation for acute variceal bleeding in the United States do not receive first‐line endoscopy during the same encounter. Patients admitted to urban hospitals are more likely to receive guideline‐concordant care. |
| first_indexed | 2024-04-10T18:07:22Z |
| format | Article |
| id | doaj.art-9db554982c024b58a6ac5e3352b7f204 |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T18:07:22Z |
| publishDate | 2021-10-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-9db554982c024b58a6ac5e3352b7f2042023-02-02T12:56:03ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2021-10-015101784179010.1002/hep4.1756High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United StatesPremal S. Trivedi0Alexandria M. Jensen1Matthew A. Brown2Rustain L. Morgan3Richard C. Lindrooth4Robert K. Ryu5P. Michael Ho6Michael S. Kriss7Department of Radiology, Division of Interventional Radiology University of Colorado Anschutz Medical Campus Aurora CO USAColorado School of Public Health Aurora CO USADepartment of Radiology, Division of Interventional Radiology University of Colorado Anschutz Medical Campus Aurora CO USADepartment of Radiology, Division of Interventional Radiology University of Colorado Anschutz Medical Campus Aurora CO USAColorado School of Public Health Aurora CO USAUniversity of Southern California Keck School of Medicine Los Angeles CA USAVeterans Affairs Eastern Colorado Health System Aurora CO USADivision of Gastroenterology and Hepatology University of Colorado Anschutz Medical Campus Aurora CO USACurrent clinical guidelines by both American Association for the Study of Liver Disease and European Association for the Study of the Liver recommend endoscopy in all patients admitted with acute variceal bleeding within 12 hours of admission. Transjugular intrahepatic portosystemic shunt (TIPS) creation may be considered in patients at high risk if hemorrhage cannot be controlled endoscopically. We conducted a cross‐sectional observational study to assess how frequently TIPS is created for acute variceal bleeding in the United States without preceding endoscopy. Adult patients undergoing TIPS creation for acute variceal bleeding in the United States (n = 6,297) were identified in the last 10 available years (2007‐2016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between endoscopy nonutilization and hospital characteristics, controlling for patient demographics, income level, insurance type, and disease severity. Of 6,297 discharges following TIPS creation for acute variceal bleeding in the United States, 31% (n = 1,924) did not receive first‐line endoscopy during the same encounter. Rates of “no endoscopy” decreased with increasing population density of the hospital county (nonmicropolitan counties 43%, n = 114; mid‐size metropolitan county 35%, n = 513; and central county with >1 million population 23%, n = 527) but not by hospital teaching status (n = 1,465, 32% teaching vs. n = 430, 26% nonteaching; P = 0.10). Higher disease mortality risk (odds ratio, 0.42; 95% confidence interval, 0.22‐0.80; P = 0.02) was associated with lower odds of noncompliance. Conclusion: One third of all patients undergoing TIPS creation for acute variceal bleeding in the United States do not receive first‐line endoscopy during the same encounter. Patients admitted to urban hospitals are more likely to receive guideline‐concordant care.https://doi.org/10.1002/hep4.1756 |
| spellingShingle | Premal S. Trivedi Alexandria M. Jensen Matthew A. Brown Rustain L. Morgan Richard C. Lindrooth Robert K. Ryu P. Michael Ho Michael S. Kriss High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States Hepatology Communications |
| title | High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States |
| title_full | High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States |
| title_fullStr | High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States |
| title_full_unstemmed | High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States |
| title_short | High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States |
| title_sort | high prevalence of transjugular intrahepatic portosystemic shunt creation without prior endoscopy during acute variceal bleeding hospitalization in the united states |
| url | https://doi.org/10.1002/hep4.1756 |
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