# Clinical Trends and Hospital Mortality of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Germany: A Descriptive Analysis Between 2019 and 2023

## TL;DR

This study analyzed TIPS procedures in Germany from 2019 to 2023, finding increased use and higher mortality in complex cases.

## Contribution

The study provides the first comprehensive analysis of TIPS trends and mortality in Germany using nationwide hospital data.

## Key findings

- TIPS procedures increased from 2180 in 2019 to 2954 in 2023.
- In-hospital mortality was 8.5%, rising to 56.1% for patients with grade 4 hepatic encephalopathy.
- Average hospital stay decreased from 19.6 to 16.8 days over the study period.

## Abstract

Background/Objectives: The transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension in patients with liver cirrhosis. While its use has increased and indications have broadened in recent years, recent comprehensive data on patient characteristics, trends, and in-hospital mortality in Germany are lacking. This study aimed to evaluate current clinical patterns and mortality outcomes associated with TIPS. Methods: This nationwide cross-sectional study used anonymized hospital data from the German InEK database between 2019 and 2023. TIPS procedures were identified using relevant OPS codes. Patient demographics, liver cirrhosis stage (Child–Pugh), hepatic encephalopathy grade, comorbid conditions, and in-hospital mortality were analyzed descriptively. Analyses were conducted using SAS 9.4. Results: A total of 12,905 TIPS procedures were documented. Annual case numbers rose from 2180 in 2019 to 2954 in 2023. Most patients were male (66.3%) and aged 60–74 years. Ascites (68.6%) was the most frequent associated diagnosis, followed by variceal bleeding (16.4%) and hepatorenal syndrome (14.9%). The average hospital stay decreased from 19.6 to 16.8 days. Overall in-hospital mortality was 8.5%, increasing with age (13.0% in ≥75 years), Child–Pugh C cirrhosis (14.9%), PCCL grade 4 (17.6%), hepatorenal syndrome (16.7%), and grade 4 hepatic encephalopathy (56.1%). Conclusions: TIPS usage in Germany has increased over the past five years, with a shift toward earlier disease stages. Higher in-hospital mortality in clinically complex patients underscores the importance of careful patient selection and tailored management strategies in high-risk groups.