Abstract No. 216 Underutilization of transjugular intrahepatic portosystemic shunt in patients over 65: trends from 2010 to 2018 among Medicare beneficiaries

A limited but growing body of evidence indicates a mortality benefit for transjugular intrahepatic portosystemic shunt (TIPS) in older patients. At the same time, the paradoxical increase in pre-transplant waitlist mortality for patients over 65 raises concern for underutilization of TIPS in this growing demographic. The purpose of this study is to analyze the trend in TIPS volume among Medicare beneficiaries from 2010 to 2018 in relation to liver transplant and associated procedures. Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File for the years 2010 to 2018 were extracted using the Current Procedural Terminology codes for liver transplant, TIPS, TIPS revision, and paracentesis. The volume of TIPS amongst Medicare beneficiaries increased by 14.4% from 1588 to 1817 patients. The volume of liver transplants increased by 51.1% from 2107 procedures to 3184 procedures. Consequently, the ratio of TIPS procedures relative to liver transplants decreased from 0.75 to 0.57.The volume of TIPS revision increased by 41.4% from 611 to 864 procedures, and the volume of paracentesis rose by 64.5% from 161,641 to 266,060 procedures. While the rate of TIPS increased modestly amongst Medicare beneficiaries from 2010 to 2018 related to a higher prevalence of end stage liver disease, its rate of increase was far less than that of liver transplant. Given increased pre-transplant waitlist morality for patients over 65, the findings of this study suggest underutilization of TIPS amongst Medicare beneficiaries. Further study of mortality and complications following TIPS in this growing patient population is necessary.