{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:58:22Z","timestamp":1785239902704,"version":"3.55.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T00:00:00Z","timestamp":1464739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Portal hypertension has seemingly vanished from surgery; this study was undertaken to determine where it has gone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>STUDY DESIGN:<\/jats:title>\n                    <jats:p>Data from the Agency for Health Care Administration for 33,166,201 hospital inpatients in Florida for the periods 1988 to 1992, 1998 to 2002, and 2008 to 2012 were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Admissions with a diagnosis of portal hypertension dramatically increased: 5,473 patients from 1988 to 1992, 7,366 patients from 1998 to 2002, and 36,554 patients from 2008 to 2012. Endoscopic treatment of esophageal varices also dramatically increased. The number of decompressive shunts placed nominally increased, but application of endoscopic therapy increased significantly faster than the application of decompressive shunts (p &lt; 0.0001). The percentage of patients who underwent shunting dramatically and significantly decreased (p &lt; 0.0001), and surgeons undertook proportionally fewer shunts (42% in 1992 to 4% in 2012; p &lt; 0.0001). For patients with a diagnosis of portal hypertension, in-hospital mortality progressively decreased, from 9% in 1988 to 1992 to 3% in 2008 to 2012 (p &lt; 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In the state of Florida, over 25 years, there has been a 7-fold increase in the number of patients admitted with a diagnosis of portal hypertension, with a 65% reduction of in-hospital mortality. Application of endoscopic treatment of varices has increased dramatically. Decompressive shunts are applied to an ever-decreasing percentage of patients, and when applied, are now routinely undertaken by nonsurgeons. Therefore, portal hypertension has disappeared from the purview of surgery and has migrated toward the world of medical and endoscopic therapy, probably never to return.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.jamcollsurg.2016.02.017","type":"journal-article","created":{"date-parts":[[2016,3,3]],"date-time":"2016-03-03T20:39:03Z","timestamp":1457037543000},"page":"1164-1170","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Portal Hypertension Over the Last 25 Years: Where Did It Go?"],"prefix":"10.1097","volume":"222","author":[{"given":"Alexander","family":"Rosemurgy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Raitano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thejal","family":"Srikumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peeraya","family":"Sawangkum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Luberice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharona","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-32-20260728","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1056\/NEJM199401203300303","article-title":"The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding","volume":"330","author":"Rossle","year":"1994","journal-title":"N Engl J Med"},{"key":"R2-32-20260728","doi-asserted-by":"crossref","first-page":"304","DOI":"10.7326\/0003-4819-116-4-304","article-title":"Using transjugular intrahepatic portosystemic shunts to control variceal bleeding before liver transplantation","volume":"116","author":"Ring","year":"1992","journal-title":"Ann Intern Med"},{"key":"R3-32-20260728","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1148\/radiology.187.2.8475283","article-title":"Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: results in 100 patients","volume":"187","author":"LaBerge","year":"1993","journal-title":"Radiology"},{"key":"R4-32-20260728","first-page":"719","article-title":"Transjugular intrahepatic portosystemic shunt in the management of variceal bleeding: indications and clinical results","volume":"114","author":"Martin","year":"1993","journal-title":"Surgery"},{"key":"R5-32-20260728","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.gassur.2004.09.028","article-title":"Current management of portal hypertension","volume":"9","author":"Wright","year":"2005","journal-title":"J Gastrointest Surg"},{"key":"R6-32-20260728","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1056\/NEJMoa0910102","article-title":"Early use of TIPS in patients with cirrhosis and variceal bleeding","volume":"362","author":"Garc\u00eda-Pag\u00e1n","year":"2010","journal-title":"N Engl J Med"},{"key":"R7-32-20260728","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1002\/hep.20559","article-title":"The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension","volume":"41","author":"Boyer","year":"2005","journal-title":"Hepatology"},{"key":"R9-32-20260728","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/00000658-199705000-00016","article-title":"Differential effects on portal and effective hepatic blood flow. 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