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JFSF Vol 8, No 2, June 2023, p.83-93

doi: 10.22540/JFSF-08-083


Original Article

Frailty as a risk-stratification tool in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS)

Aalam Sohal1*, Hunza Chaudhry2*, Isha Kohli3, Kirti Arora4, Jay Patel5, Nimrat Dhillon6, Ishandeep Singh4, Dino Dukovic7, Marina Roytman8

  1. Department of Hepatology, Liver Institute Northwest, Seattle, USA
  2. Department of Internal Medicine, University of California, San Francisco, Fresno, USA
  3. Department of Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
  4. Dayanand Medical College and Hospital, India
  5. Department of Internal Medicine, Orange Park Medical Center, Orange Park, Florida, USA
  6. Shri Guru Ram Das Medical College, India
  7. Ross University School of Medicine, Barbados, USA
  8. Department of Gastroenterology and Hepatology, University of California, San Francisco, Fresno, USA
  • * Equal contribution

Keywords: Cirrhosis, Emerging, Frailty, National Inpatient Sample, TIPS


Objectives: The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods: We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. Results: A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Conclusion: Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.
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