Post-Shunt Resource Consumption Favors Small-Diameter Prosthetic H-Graft Portacaval Shunt over TIPS for Patients with Poor Hepatic Reserve

Alexander S. Rosemurgy, Emmanuel E. Zervos, Mark Bloomston, Alan J. Durkin, Whalen C. Clark, Stephanie Goff, J. Michael Henderson, David V. Feliciano, Layton F. Rikkers, Jeffrey Fair

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS. Summary Background Data: Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival. Methods: Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999. Resource consumption and survival after shunting were determined. Results: Twenty-nine patients underwent TIPS and 33 underwent HGPCS. After HGPCS, survival at 3 years was favorable but not statistically superior. TIPS was more often associated with shunt stenoses/occlusions, recurrent hemorrhage, shunt revisions, and shunt failure. Long-term follow-up documented that after HGPCS, patients required fewer hospital and ICU days and fewer units of RBCs transfused. After HGPCS, cost of care was less, as was the median cost of care per day of survival. Conclusions: For Child's class C patients undergoing HGPCS or TIPS, long-term survival is similar, though favoring HGPCS. Similarly, measures of resource consumption and cost of care following hospital discharge favor HGPCS. HGPCS should be preferentially applied for acceptable patients without access to convenient capable post-shunt care or without definitive plans for imminent transplantation.

Original languageEnglish (US)
Pages (from-to)820-827
Number of pages8
JournalAnnals of Surgery
Volume237
Issue number6
DOIs
StatePublished - Jun 2003
Externally publishedYes

Fingerprint

Surgical Portacaval Shunt
Transplants
Liver
Survival
Costs and Cost Analysis
Hemorrhage
Sclerotherapy
Varicose Veins
Pathologic Constriction
Transplantation
Physicians

ASJC Scopus subject areas

  • Surgery

Cite this

Post-Shunt Resource Consumption Favors Small-Diameter Prosthetic H-Graft Portacaval Shunt over TIPS for Patients with Poor Hepatic Reserve. / Rosemurgy, Alexander S.; Zervos, Emmanuel E.; Bloomston, Mark; Durkin, Alan J.; Clark, Whalen C.; Goff, Stephanie; Henderson, J. Michael; Feliciano, David V.; Rikkers, Layton F.; Fair, Jeffrey.

In: Annals of Surgery, Vol. 237, No. 6, 06.2003, p. 820-827.

Research output: Contribution to journalArticle

Rosemurgy, AS, Zervos, EE, Bloomston, M, Durkin, AJ, Clark, WC, Goff, S, Henderson, JM, Feliciano, DV, Rikkers, LF & Fair, J 2003, 'Post-Shunt Resource Consumption Favors Small-Diameter Prosthetic H-Graft Portacaval Shunt over TIPS for Patients with Poor Hepatic Reserve', Annals of Surgery, vol. 237, no. 6, pp. 820-827. https://doi.org/10.1097/00000658-200306000-00010
Rosemurgy, Alexander S. ; Zervos, Emmanuel E. ; Bloomston, Mark ; Durkin, Alan J. ; Clark, Whalen C. ; Goff, Stephanie ; Henderson, J. Michael ; Feliciano, David V. ; Rikkers, Layton F. ; Fair, Jeffrey. / Post-Shunt Resource Consumption Favors Small-Diameter Prosthetic H-Graft Portacaval Shunt over TIPS for Patients with Poor Hepatic Reserve. In: Annals of Surgery. 2003 ; Vol. 237, No. 6. pp. 820-827.
@article{90c14b23d8f843d3bd55139e2bdeb924,
title = "Post-Shunt Resource Consumption Favors Small-Diameter Prosthetic H-Graft Portacaval Shunt over TIPS for Patients with Poor Hepatic Reserve",
abstract = "Objective: To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS. Summary Background Data: Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival. Methods: Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999. Resource consumption and survival after shunting were determined. Results: Twenty-nine patients underwent TIPS and 33 underwent HGPCS. After HGPCS, survival at 3 years was favorable but not statistically superior. TIPS was more often associated with shunt stenoses/occlusions, recurrent hemorrhage, shunt revisions, and shunt failure. Long-term follow-up documented that after HGPCS, patients required fewer hospital and ICU days and fewer units of RBCs transfused. After HGPCS, cost of care was less, as was the median cost of care per day of survival. Conclusions: For Child's class C patients undergoing HGPCS or TIPS, long-term survival is similar, though favoring HGPCS. Similarly, measures of resource consumption and cost of care following hospital discharge favor HGPCS. HGPCS should be preferentially applied for acceptable patients without access to convenient capable post-shunt care or without definitive plans for imminent transplantation.",
author = "Rosemurgy, {Alexander S.} and Zervos, {Emmanuel E.} and Mark Bloomston and Durkin, {Alan J.} and Clark, {Whalen C.} and Stephanie Goff and Henderson, {J. Michael} and Feliciano, {David V.} and Rikkers, {Layton F.} and Jeffrey Fair",
year = "2003",
month = "6",
doi = "10.1097/00000658-200306000-00010",
language = "English (US)",
volume = "237",
pages = "820--827",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Post-Shunt Resource Consumption Favors Small-Diameter Prosthetic H-Graft Portacaval Shunt over TIPS for Patients with Poor Hepatic Reserve

AU - Rosemurgy, Alexander S.

AU - Zervos, Emmanuel E.

AU - Bloomston, Mark

AU - Durkin, Alan J.

AU - Clark, Whalen C.

AU - Goff, Stephanie

AU - Henderson, J. Michael

AU - Feliciano, David V.

AU - Rikkers, Layton F.

AU - Fair, Jeffrey

PY - 2003/6

Y1 - 2003/6

N2 - Objective: To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS. Summary Background Data: Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival. Methods: Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999. Resource consumption and survival after shunting were determined. Results: Twenty-nine patients underwent TIPS and 33 underwent HGPCS. After HGPCS, survival at 3 years was favorable but not statistically superior. TIPS was more often associated with shunt stenoses/occlusions, recurrent hemorrhage, shunt revisions, and shunt failure. Long-term follow-up documented that after HGPCS, patients required fewer hospital and ICU days and fewer units of RBCs transfused. After HGPCS, cost of care was less, as was the median cost of care per day of survival. Conclusions: For Child's class C patients undergoing HGPCS or TIPS, long-term survival is similar, though favoring HGPCS. Similarly, measures of resource consumption and cost of care following hospital discharge favor HGPCS. HGPCS should be preferentially applied for acceptable patients without access to convenient capable post-shunt care or without definitive plans for imminent transplantation.

AB - Objective: To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS. Summary Background Data: Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival. Methods: Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999. Resource consumption and survival after shunting were determined. Results: Twenty-nine patients underwent TIPS and 33 underwent HGPCS. After HGPCS, survival at 3 years was favorable but not statistically superior. TIPS was more often associated with shunt stenoses/occlusions, recurrent hemorrhage, shunt revisions, and shunt failure. Long-term follow-up documented that after HGPCS, patients required fewer hospital and ICU days and fewer units of RBCs transfused. After HGPCS, cost of care was less, as was the median cost of care per day of survival. Conclusions: For Child's class C patients undergoing HGPCS or TIPS, long-term survival is similar, though favoring HGPCS. Similarly, measures of resource consumption and cost of care following hospital discharge favor HGPCS. HGPCS should be preferentially applied for acceptable patients without access to convenient capable post-shunt care or without definitive plans for imminent transplantation.

UR - http://www.scopus.com/inward/record.url?scp=0038452609&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0038452609&partnerID=8YFLogxK

U2 - 10.1097/00000658-200306000-00010

DO - 10.1097/00000658-200306000-00010

M3 - Article

C2 - 12796578

AN - SCOPUS:0038452609

VL - 237

SP - 820

EP - 827

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -