Background Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive therapeutic option to treat complications of portal hypertension. TIPS can provide long-term symptom control and prolong transplant-free survival. Recently, novel endovascular techniques, improved TIPS stent technology, and extended indications have emerged, prompting updates to international guidelines. It is unclear whether these updates are reflected in current clinical practice across TIPS centres in Australia. Moreover, there is a paucity of real-life data regarding TIPS indications, patient selection, and outcomes. Here, we investigated existing practices and benchmarked the current landscape of TIPS provision in Australia against international guidelines to assess the need for a national clinical practice guideline.

Methods We designed a 42-item questionnaire to investigate the current landscape of TIPS services across four key domains: patient selection, best procedure practice, post-operative management, and service development.

Results 23 (68%) TIPS centres completed the questionnaire. This nationwide study demonstrated that the TIPS procedure is not commonly performed. Between 2017 and 2019, there were only 456 elective TIPS insertions. Units offering TIPS had a low annual caseload with 7 TIPS implantations per year. Remarkably, more than half of TIPS centres (56%) lacked institutional clinical practice guidance or any standard of care protocols, for many aspects of the TIPS procedure. More than one-third of TIPS centres are not providing pre-emptive ‘early’ TIPS for qualifying patients. There was marked variation in routine clinical practice across institutions for TIPS indications and patient selection. Despite this variation, success rates of elective procedures were high (92%), while the success rate of rescue TIPS was 87%. There was significant variation in post-TIPS follow-up care.

Conclusions This survey represents a baseline snapshot of TIPS in ‘real life’ in Australia. The current practices differ drastically across institutions. Significant discrepancies between international guidelines for TIPS and current Australian practice exist, underscoring the need for a national consensus and registry to reduce clinical variation, improve TIPS uptake, and monitor the quality of care and outcomes.