Is 70 the new 50? Complications and outcomes of transjugular intrahepatic portosystemic shunt in older versus younger patients

Bisht, Roy; Liu, Margaret C.; Koblinski, Jenna E.; Kang, Paul; Wong, Mark; Little, Ester C.

doi:10.1007/s00261-020-02533-3

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…Six studies with a total of 1,591 patients met our inclusion criteria and were included in the final meta-analysis [28][29][30][31][32][33]. Three studies divided patients by age < 65 vs. > 65 years, with a total of 816 patients who were 54% male.…”

Section: Resultsmentioning

confidence: 99%

“…1) elaborates our systematic literature search process. Baseline characteristics, including patient demographics and indications for TIPS, are reported in Tables 2 and 3 [28][29][30][31][32][33]. Publication bias was not assessed due to the low number of studies.…”

Section: Resultsmentioning

confidence: 99%

“…MINORS was used to assess the quality of the studies (Table 1) [28][29][30][31][32][33]. Non-comparative studies were graded on eight MINORS criteria, with each item ranging from 0 to 2 (0 if not reported; 1 if reported but inadequate; 2 if reported and adequate), and a global score of 16 for non-comparative studies and 24 for comparative analyses considered ideal.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Transjugular Intrahepatic Portosystemic Shunt Outcomes in the Elderly Population: A Systematic Review and Meta-Analysis

et al. 2022

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Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure typically utilized to treat refractory ascites and variceal bleeding. However, TIPS can lead to significant complications, most commonly hepatic encephalopathy (HE). Advanced age has been described as a risk factor for HE, as the elderly population tends to have decreased cognitive reserve and increased sarcopenia. We conducted a systematic review and meta-analysis of the available literature to summarize the association between advanced age and risk of adverse events after undergoing TIPS. Methods:A comprehensive search strategy to identify reports of specific outcomes (HE, 30-day and 90-day mortality, and 30-day readmission due to HE) in elderly patients after undergoing TIPS was developed in Embase (Embase.com, Elsevier). We compared outcomes and performed separate data analyses for patients aged < 70 vs. > 70 years and patients aged < 65 vs. > 65 years.Results: Six studies with a total of 1,591 patients met our inclusion criteria and were included in the final meta-analysis. Three studies divided patients by age < 65 vs. > 65 years, with a total of 816 patients who were 54% male. The remaining three studies divided patients by age < 70 vs. > 70 years, with a total of 775 patients who were 63% male. Results demonstrated a significantly lower risk of post-TIPS HE (risk ratio (RR): 0.42, confidence interval (CI): 0.185 -0.953, P = 0.03, I 2 = 49%), 30-day mortality (RR: 0.37, CI: 0.188 -0.74, P = 0.005, I 2 = 0%), and 90-day mortality (RR: 0.35, CI: 0.24 -0.49, P = 0.001, I 2 = 0%) in patients aged > 70 vs. < 70 years, as well as a trend towards lower risk of 30-day readmission due to HE. There was no significant difference in post-TIPS HE, 30-day or 90-day mortality, or 30-day readmission due to HE between patients aged < 65 vs. > 65 years. Conclusion:Age > 70 years is associated with significantly higher rates of HE and 30-day and 90-day mortality rates in patients after undergoing TIPS, as well as a trend towards higher 30-day readmission due to HE.

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