背景:这项研究旨在探讨美洲原住民经颈静脉肝内门体分流术(TIPS)的直接结果的种族差异,一组肝硬化患病率较高,但在以前的TIPS研究中,由于其人口规模较小,他们是“隐形组”。
方法:该研究确定了2015-2020年第四季度在国家/全国住院样本(NIS)数据库中接受TIPS的美洲原住民和白种人。术前因素,包括人口统计,提示的指示,合并症,肝病的病因,主要付款人身份,和医院的特点,与1:5的倾向得分匹配。然后比较两个队列之间的住院TIPS后结果。
结果:有6,658名患者接受了TIPS,其中101(1.52%)是美洲原住民,4,574(68.70%)是白种人。美洲原住民表现得更年轻,社会经济地位较低,并显示出更高的酒精滥用率和相关的肝脏疾病。在倾向得分匹配后,美洲原住民在住院后的TIPS结果具有可比性,包括死亡率(8.33%vs9.09%,p=1.00),肝性脑病(18.75%vs25.84%,p=0.19),急性肾损伤(28.13%vs30.62%,p=0.71),和其他不良事件。美洲原住民从入院到手术也有类似的等待时间(2.15±0.30vs2.87±0.21天,p=0.13),住院时间(7.43±0.63vs8.62±0.47天,p=0.13),和总成本(158,299±14,218.2vs169,425±8,600.7美元,p=0.50)。
结论:与倾向匹配的白种人相比,美洲原住民在TIPS后的即时结果相似。虽然这些结果强调了向美洲原住民提供TIPS的有效医疗保健服务,必须进一步研究手术后的长期结果。
BACKGROUND: This study aims to explore racial disparities in immediate outcomes of Transjugular Intrahepatic Portosystemic Shunt (TIPS) among Native Americans, a group that have higher prevalence of liver cirrhosis but were the \"invisible group\" in previous TIPS studies due to their small population size.
METHODS: The study identified Native Americans and Caucasians who underwent TIPS in National/Nationwide Inpatient Sample (NIS) database from Q4 2015-2020. Preoperative factors, including demographics, indications for TIPS, comorbidities, etiologies for liver disease, primary payer status, and hospital characteristics, were matched by 1:5 propensity score matching. In-hospital post-TIPS outcomes were then compared between the two cohorts.
RESULTS: There were 6,658 patients who underwent TIPS, where 101 (1.52%) were Native Americans and 4,574 (68.70%) were Caucasians. Native Americans presented as younger, with a lower socioeconomic status, and displayed higher rates of alcohol abuse and related liver diseases. After propensity-score matching, Native Americans had comparable in-hospital post-TIPS outcomes including mortality (8.33% vs 9.09%, p = 1.00), hepatic encephalopathy (18.75% vs 25.84%, p = 0.19), acute kidney injury (28.13% vs 30.62%, p = 0.71), and other adverse events. Native Americans also had similar wait from admission to operation (2.15 ± 0.30 vs 2.87 ± 0.21 days, p = 0.13), hospital length of stay (7.43 ± 0.63 vs 8.62 ± 0.47 days, p = 0.13), and total costs (158,299 ± 14,218.2 vs 169,425 ± 8,600.7 dollars, p = 0.50).
CONCLUSIONS: Native Americans had similar immediate outcomes after TIPS compared to their propensity-matched Caucasians. While these results underscore effective healthcare delivery of TIPS to Native Americans, it is imperative to pursue further research for long-term post-procedure outcomes.