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Hospital readmission following transjugular intrahepatic portosystemic shunt: a 14-year single-center experience

机译:医院入院后的秘方肝内portosystemic分流器:14年的单中心经验

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BackgroundPlacement of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively common procedure used to treat complications of portal hypertension. However, only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital readmission. We therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of readmission.MethodsWe reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients. A series of univariable logistic-regression models were fit to assess potential predictors of 30-day readmission.ResultsA total of 566 patients were included in the analysis. The 30-day readmission rate after TIPS placement was 36%. The most common causes for readmission were confusion (48%), infection (15%), bleeding (11%), and fluid overload (7%). A higher Model for End-Stage Liver Disease (MELD) score corresponded with a higher rate of readmission (odds ratio associated with each 1-unit increase in MELD score: 1.06; 95% confidence interval: 1.02–1.09; P?=?0.001). Other potential predictors, including indication for TIPS placement, were not significantly associated with a higher readmission rate.ConclusionsThe 30-day readmission rate after TIPS placement with covered stents is high, with nearly half of these readmissions due to hepatic encephalopathy—a known complication of TIPS placement. Novel interventions to help reduce the TIPS readmission rate should be prioritized in future research.
机译:Transjugular肝内portoSystemic分流器(提示)的背景是用于治疗门静脉高血压并发症的相对常见的程序。然而,在提示放置后,只有有关医院入院率的有限数据,并且没有研究已经解决了医院入院的原因。因此,我们试图在我们机构的提示后确定为期30天的医院入院率,并确定Readmission的潜在原因和预测因素.Thodswe在2004年至2017年期间审查了我们的电子医疗记录系统,以确定经历过的患者用聚四氟乙烯覆盖的支架进行初级提示,并确定这些患者的30天的阅览率。一系列单变逻辑回归模型适合评估30天的潜在预测因子。分析中包含566名患者的总共566名患者。提示放置后的30天登记率为36%。即入患者的最常见原因是混淆(48%),感染(15%),出血(11%)和流体过载(7%)。较高模型的终末期肝病(MELD)评分与较高的再入液率(与每个1单元相关的差异比率相关的差距:1.06; 95%置信区间:1.02-1.09; P?= 0.001 )。包括提示放置的迹象,包括提示的迹象,与更高的入院率没有显着相关。包括覆盖支架的提示后30天的入院率为高,因此由于肝脑病导致的这些入伍的近一半 - 一种已知的并发症提示放置。应在未来的研究中优先考虑降低提示速度的新型干预措施。

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