Ammar Sarwar MD, Presenter: Nothing to Disclose

Elliot Tapper, Abstract Co-Author: Nothing to Disclose

Douglas Grunwald, Abstract Co-Author: Nothing to Disclose

Salomao Faintuch MD, Abstract Co-Author: Nothing to Disclose

Raza Malik, Abstract Co-Author: Nothing to Disclose

Muneeb Ahmed MD, Abstract Co-Author: Nothing to Disclose

Readmission of patients within 30 days of discharge is a quality metric used by the Center for Medicare and Medicaid Services, which is linked to financial penalties. We examined 30 day re-admissions and outcomes after inpatient transjugular intrahepatic portosystemic shunt (TIPS) procedures at our institution to identify the most common causes for re-admission.

We searched for all TIPS placed at our institution from May 2003 to May 2013 using CPT codes and review of our interventional radiology database. In total, there were 168 primary TIPS procedures performed with 94 covered stents and 74 uncovered stents. We reviewed electronic medical records, radiology reports, administrative databases and discharge summaries. Of these patients, we evaluated the type of TIPS stent used (covered vs. uncovered), length of stay, readmission rates, 30 day re-admissions and overall mortality.

Between May 2003 to May 2013, 168 primary TIPS were placed in 168 patients (55±11 yrs, 71% male). 83/168 were for refractory ascites and 85/168 were for variceal bleeding. 17/168 procedures required only overnight admission whereas 151 required extended hospitalization (12±12 days). Readmission was required in 31/168 (18%) patients within 30 days of discharge after the TIPS procedure. Causes for readmission included encephalopathy (8/31, 25%), clinical symptoms requiring TIPS revisions (6/31, 19%), ascites or hydrothorax causing shortness of breath (6/31, 19%), acute renal failure (3/31, 9%), fluid/electrolyte imbalance (3/31, 9%), sepsis (2/31, 6%) and others (3/31, 9%). Only 1/8 patients with encephalopathy required TIPS reduction. Overall, 7 day mortality was 6/168, 30 day mortality was 19/168 and overall mortality was 64/168 occuring 1-2343 days (431±571 days after TIPS). 

We report single center results for 30 day readmissions following TIPS placement. The most common reason for readmission is hepatic encephalopathy, which can be medically managed in a majority of patients. Assigning more resources post-discharge to high-risk patients may reduce readmission rates.

30 day readmission rates are a CMS metric with potential financial penalties. There is limited current data on 30 day readmission rates following TIPS placement.

Sarwar, A, Tapper, E, Grunwald, D, Faintuch, S, Malik, R, Ahmed, M, 30-day Readmission Rate following Transjugular Intrahepatic Portosystemic Shunt (TIPS) Placement: A Single Center Experience.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045801.html