S2530 Obesity and Its Association With Clinical Outcomes and Readmissions After TIPS: A Propensity Matched Analysis Using Nationwide Readmissions Database 2017-2021

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to relieve portal hypertension in patients with decompensated liver cirrhosis. Obesity may influence procedural risk and outcomes after TIPS placement, but large-scale data are lacking. We assessed the impact of obesity on in-hospital mortality, 30-day readmission, and clinical complications following TIPS. Methods: This is a retrospective analysis using data from the National Readmission Database for the years 2017-2021. We included all the patients aged over 18 years who underwent TIPS, stratified based on obesity. Primary outcomes included mortality and all-cause 30-day readmissions. Secondary outcomes included length of stay, total hospitalization charges, sepsis, acute kidney injury (AKI), shock, post-procedural hemorrhage, and hepatic encephalopathy. Univariate and Multivariate regression analyses were used to evaluate the outcomes among 2 cohorts. To further address confounding propensity scores were estimated by incorporating age, gender, charlson comorbidity index(CCI), hospital bed-size, teaching status and median income, after which the outcomes were analyzed. P value < 0.05 was considered statistically significant. Results: A total of 29,334 patients underwent TIPS, among whom 4,858 (16.6%) were obese. There was no significant difference in mortality between the 2 groups. All-cause readmissions was higher in the obese cohort compared to the control. All other outcomes were insignificant between 2 groups except shock, which was associated with being lower in the obese cohort compared to control. Post-TIPS, obese cohort was more likely to be discharged to a skilled nursing facility compared to controls. Statistically significant independent predictors of 30-day all-cause readmissions following TIPS included advanced age, a high CCI, admission to a metropolitan teaching hospital, shock, and AKI. Conclusion: Our study found that obesity and TIPS was associated with lower odds of shock and higher odds of all-cause readmissions compared to controls. Obese patients were more likely to be discharged to a skilled nursing facility compared to non-obese patients. These findings highlight the potential need for enhanced discharge planning and post-discharge support strategies in obese patients undergoing TIPS. Future research should explore the role of obesity severity and tailored interventions to reduce readmissions.