{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:59:22Z","timestamp":1772607562458,"version":"3.50.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T00:00:00Z","timestamp":1553472000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure designed to treat portal hypertension. Hospital teaching status is an institutional factor found to be predictive of outcomes following several complex procedures; however, its impact on outcomes following TIPS is unknown. The aim of this study was to determine the association between hospital teaching status and long\u2010term survival in patients with cirrhosis receiving TIPS. We performed a retrospective population\u2010based cohort study using linked administrative health data from Ontario, Canada. Adult patients with cirrhosis who received TIPS between January 1, 1998, and December 31, 2016, with follow\u2010up until December 31, 2017, were included. Hospital teaching status was defined based on hospital participation in the instruction of medical students and\/or resident physicians. Liver transplant\u2010free (LTF) survival was evaluated using Kaplan\u2010Meier analysis, and overall survival was assessed using competing risks regression analysis, which accounted for hospital clustering. A total of 857 unique patients were included (mean age 57.1\u00a0years; 69.1% male). The TIPS procedures were performed in teaching hospitals (84.3%) as well as nonteaching hospitals (15.7%). Median LTF survival was more than twice as long for procedures performed in teaching hospitals compared to nonteaching hospitals (2.2\u00a0years versus 0.9\u00a0year, respectively; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). After adjusting for confounders and clustering, hospital teaching status was not independently associated with mortality (nonteaching subdistribution hazard ratio [sHR], 1.32; 95% confidence interval [CI], 0.97\u20101.81; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.08); however, annual hospital procedure volume was (per unit increase sHR, 0.96; 95% CI, 0.93\u20100.99; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.003). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Hospital procedure volume is associated with long\u2010term survival following TIPS. These results further support the centralization of TIPS to high\u2010volume hospitals to improve long\u2010term outcomes in this population.<\/jats:p>","DOI":"10.1002\/hep4.1345","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T18:57:15Z","timestamp":1553540235000},"page":"838-846","source":"Crossref","is-referenced-by-count":11,"title":["Association Between Institutional Factors and Long\u2010Term Survival Following Transjugular Intrahepatic Portosystemic Shunt"],"prefix":"10.1097","volume":"3","author":[{"given":"Jeffrey M.","family":"Mah","sequence":"first","affiliation":[{"name":"Department of Medicine,Queen\u2019s University,Kingston,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne","family":"DeWit","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences,Queen\u2019s University,Kingston,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Djerboua","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences,Queen\u2019s University,Kingston,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Menard","sequence":"additional","affiliation":[{"name":"Department of Radiology,Queen\u2019s University,Kingston,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M.","family":"Booth","sequence":"additional","affiliation":[{"name":"Department of Medicine,Queen\u2019s University,Kingston,Canada"},{"name":"Institute for Clinical Evaluative Sciences,Queen\u2019s University,Kingston,Canada"},{"name":"Department of Public Health Sciences,Queen\u2019s University,Kingston,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A.","family":"Flemming","sequence":"additional","affiliation":[{"name":"Department of Medicine,Queen\u2019s University,Kingston,Canada"},{"name":"Institute for Clinical Evaluative Sciences,Queen\u2019s University,Kingston,Canada"},{"name":"Department of Public Health Sciences,Queen\u2019s University,Kingston,Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2019,3,25]]},"reference":[{"key":"hep41345-bib-0001-20240114","first-page":"1","article-title":"Deaths: leading causes for 2014","volume":"65","year":"2016","journal-title":"Natl Vital Stat Rep"},{"key":"hep41345-bib-0002-20240114","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S2468-1253(18)30339-X","article-title":"Incidence of cirrhosis in young birth cohorts in Canada from 1997 to 2016: a retrospective population\u2010based study","volume":"4","year":"2019","journal-title":"Lancet Gastroenterol 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