1116 The Role of Perioperative Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients Undergoing Extrahepatic Surgery

INTRODUCTION: The use of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the perioperative period in cirrhotic patients with portal hypertension has been limited to small case series. The aim of this study is to describe a multi-center experience with the use of TIPS prior to abdominal surgery in patients with cirrhosis and portal hypertension. METHODS: In a retrospective multi-center case-matched study, we compared outcomes between patients with cirrhosis who received TIPS prior to abdominal surgery and patients who did not. Patients with liver transplantation were excluded. All patients had ascites and were matched 1/1 for same surgical procedure and for similar Model for End Stage Liver Disease (MELD) score. Outcomes evaluated included MELD scores at 30- and 180-day post-surgery, bleeding varices, development of hepatic encephalopathy, medical and surgical complications, 30- and 180-day mortality, length of hospital stay, and 30-day readmission rate. Statistical significance was determined using a paired t test and Fischer’s exact test. RESULTS: There were 14 patients in each group. In each group, 5 patients (35.7%) underwent colorectal surgery and the remainder underwent umbilical hernia repair. The majority of patients in both cohorts had advanced cirrhosis as characterized by their pre-operative Child Pugh score B and C. TIPS was performed an average of 18.4 days prior to surgery. In the post-operative period, 4 patients with TIPS had ascites compared to 12 patients without TIPS ( P = 0.006). Post-operative hepatic encephalopathy and esophageal variceal bleeding were more common in the non-TIPS cohort. Length of stay was 11.4 days in TIPS patients and 6.6 days in non-TIPS patients ( P = 0.19). Five TIPS patients (35.7%) were re-admitted within 30-days compared to 7 non-TIPS patients (50%) ( P = 0.7). CONCLUSION: Our study indicates that preoperative TIPS significantly improved ascites post TIPS in cirrhotic patients with portal hypertension in comparison with patients who did not receive TIPS. Our study also shows improvement although not statistically significant in 30- and 180-day MELD scores, incidence of esophageal variceal bleeding, incidence of hepatic encephalopathy, post-operative medical and surgical complications, and 180-day mortality. TIPS did not improve length of stay or readmission rates. TIPS appears to have a role in patients with cirrhosis however further studies are required to better characterize the potential benefit of TIPS in the perioperative period.