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Recent TIPS increases postoperative mortality: A national cohort study.

Helen Tang1, David E Kaplan2,3, Samir Abu-Gazala4

  • 1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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|December 2, 2024
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Summary
This summary is machine-generated.

Preoperative transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis undergoing major surgery was linked to higher postoperative mortality and poorer liver function. Careful consideration is advised for patients with cirrhosis before surgery.

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Area of Science:

  • Hepatology
  • Surgical Oncology
  • Critical Care Medicine

Background:

  • Cirrhosis increases postoperative mortality risk, partly due to portal hypertension.
  • Preoperative transjugular intrahepatic portosystemic shunt (TIPS) placement may mitigate surgical risks.
  • Previous studies on preoperative TIPS benefits were limited by confounding and lack of longitudinal data.

Purpose of the Study:

  • To evaluate the association between preoperative TIPS placement and postoperative mortality in patients with cirrhosis.
  • To analyze the impact of TIPS on longitudinal liver function markers before major surgery.

Main Methods:

  • Retrospective cohort study using Veterans Health Administration data (2008-2022).
  • Identified patients with cirrhosis undergoing major surgery and TIPS placement within 6 months preoperatively.
  • Propensity score matching (5:1) used to compare outcomes between TIPS and non-TIPS groups, incorporating demographics, comorbidities, surgery type, and lab data.

Main Results:

  • The propensity-matched cohort included 39 patients with preoperative TIPS and 171 without.
  • Cox regression revealed preoperative TIPS was associated with increased postoperative mortality (HR: 2.69).
  • TIPS patients showed worsened liver synthetic function (lower albumin, higher bilirubin and INR) immediately before surgery compared to non-TIPS patients.

Conclusions:

  • Recent preoperative TIPS placement is associated with increased postoperative mortality in cirrhotic patients undergoing major surgery.
  • TIPS placement negatively impacts liver synthetic function in the immediate preoperative period.
  • Careful consideration of preoperative TIPS is crucial for cirrhotic patients facing major surgery.