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Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion.

Publication ,  Journal Article
Chiang, RS; Parish, A; Niedzwiecki, D; Kappus, MR; Muir, AJ
Published in: Dig Dis Sci
November 2020

BACKGROUND: Malnutrition is common in patients with cirrhosis and is associated with poor outcomes after hepatic resection and liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) is performed for complications of cirrhosis. AIM: To assess the impact of malnutrition on TIPS outcomes. METHODS: A retrospective analysis was performed using the Healthcare Cost and Utilization Project: National Inpatient Sample database for TIPS procedures from 2005 to 2014. The primary end point was in-hospital mortality. The association of specific malnutrition diagnostic codes and race-ethnicity on mortality was evaluated with survey-weighted logistic regression adjusted for age, gender, admission type, insurance payer, hospital region, comorbidities, and length of stay (LOS). RESULTS: From 2005 to 2014, an estimated 53,207 (95% CI 49,330-57,085) admissions with TIPS occurred. A diagnosis of malnutrition was present in 11%. In-hospital death post-TIPS occurred in 15.0% versus 10.7% (p value < 0.001) of patients with and without malnutrition, respectively. Patients with malnutrition had longer post-procedural LOS (median 6.7 vs. 2.9 days, p value < 0.001) and greater total hospital charges (median $144,752 vs. $79,781, p value < 0.001) and were more likely to be discharged to a skilled nursing facility (21.6% vs. 9.7%) than patients without malnutrition. Patients with malnutrition had increased odds of mortality (OR 1.31, 95% CI 1.07, 1.59) compared to patients with no malnutrition. CONCLUSION: Malnutrition was associated with worse outcomes after TIPS. Further research is needed to understand the mechanism of malnutrition in post-procedure outcomes and the ability of interventions for nutritional optimization to improve outcomes.

Duke Scholars

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Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

November 2020

Volume

65

Issue

11

Start / End Page

3332 / 3340

Location

United States

Related Subject Headings

  • Skilled Nursing Facilities
  • Retrospective Studies
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Middle Aged
  • Malnutrition
  • Male
  • Liver Cirrhosis
  • Length of Stay
  • Humans
  • Hospital Charges
 

Citation

APA
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ICMJE
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Chiang, R. S., Parish, A., Niedzwiecki, D., Kappus, M. R., & Muir, A. J. (2020). Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion. Dig Dis Sci, 65(11), 3332–3340. https://doi.org/10.1007/s10620-019-06038-y
Chiang, Ryan S., Alice Parish, Donna Niedzwiecki, Matthew R. Kappus, and Andrew J. Muir. “Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion.Dig Dis Sci 65, no. 11 (November 2020): 3332–40. https://doi.org/10.1007/s10620-019-06038-y.
Chiang RS, Parish A, Niedzwiecki D, Kappus MR, Muir AJ. Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion. Dig Dis Sci. 2020 Nov;65(11):3332–40.
Chiang, Ryan S., et al. “Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion.Dig Dis Sci, vol. 65, no. 11, Nov. 2020, pp. 3332–40. Pubmed, doi:10.1007/s10620-019-06038-y.
Chiang RS, Parish A, Niedzwiecki D, Kappus MR, Muir AJ. Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion. Dig Dis Sci. 2020 Nov;65(11):3332–3340.
Journal cover image

Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

November 2020

Volume

65

Issue

11

Start / End Page

3332 / 3340

Location

United States

Related Subject Headings

  • Skilled Nursing Facilities
  • Retrospective Studies
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Middle Aged
  • Malnutrition
  • Male
  • Liver Cirrhosis
  • Length of Stay
  • Humans
  • Hospital Charges