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Title: Transjugular Intrahepatic Portosystemic Shunt (TIPS), Duration of Procedural Time and Correlation with Early Morbidity and MortalityAuthor: Juan Carlos Barrera Gutierrez, PhD., Candidate in EpidemiologyABSTRACTPurpose: 1. To examine the relationship between patient factors (demographics or clinical) and duration of TIPS procedure.2.To determine if duration of TIPS procedure is associated with early morbidity, including acute kidney injury, liver dysfunction, and intraoperative or postoperative bleeding. 3.Determine if duration of TIPS procedure is related to early mortality (or operative mortality).Materials and Methods: Data for this retrospective study was abstracted using the REDcap system from patients' electronic records. Inclusion criteria were patients over 18 years of age who underwent an initial TIPS procedure (for any indication) between January 2005 and August 2020. Exclusion criteria were those TIPS performed out of the institution and failed TIPS procedures. Regression analysis was used to identify the predictors of procedural time, the predictors of morbidity and mortality.Results: The mean age at TIPS procedure was 57 years. Most patients (70%) were male, and Non-Hispanic whites made up the largest group (80.5%). The main predictor of procedural time was baseline bilirubin (beta coefficient: 4.9 minutes, p = 0.005) in those patients that did not require extra access. Additionally etiology of cirrhosis and staff experience were predictors of procedural time. The main predictor of acute kidney injury (AKI) immediately after TIPS were gender (p = 0.02) and body mass index (BMI) (p = 0.04). MELD score (p = 0.02), age (p = 0.003), gender (p = 0.001), and time (p = 0.01) became the best predictors of liver function post TIPS in those patients with ascites and who did not require extra access. The mortality rate in the first month after TIPS was 14.5%, and the predictors associate to this were MELD score (OR: 1.17, p=0.004), AKI (OR: 14.7, p=0.003), BMI (OR: 0.856, p=0.04), and type of TIPS procedure (OR: 4.4, p=0.04).Conclusions: The findings of this study demonstrated an association between baseline bilirubin, etiology of cirrhosis, and staff experience with the duration of the TIPS procedure. Women had an increased risk of AKI when compared with men, and BMI was a protective factor for women, but not for men. Increase in procedural time of TIPS was associated with impaired liver function, manifested through an increase in bilirubin levels after TIPS, in a subset of patients with ascites that did not require additional accesses. In this study the operative or early mortality of TIPS procedure was 14.5%. Predictors of mortality included MELD score, AKI, BMI, and type of TIPS procedure.