目的:经颈静脉肝内门体分流术(TIPS)是一种用于缓解慢性肝硬化和门脉高压患者的手术。吸烟会对肝功能产生不利影响,并已被证明会影响肝脏相关的结果。这项研究旨在检查吸烟对TIPS程序的直接结果的影响。
方法:该研究比较了2015年最后一个季度至2020年在国家住院患者样本(NIS)数据库中接受TIPS程序的吸烟者和非吸烟者。多变量分析用于比较TIPS后的住院结局。调整后的程序前变量包括性别,年龄,种族,社会经济地位,提示的指示,肝病病因,合并症,医院特色。
结果:与非吸烟者相比,吸烟者住院死亡率风险较低(7.36%vs9.88%,OR0.662,p<0.01),急性肾损伤(25.57%vs33.66%,OR0.68,p<0.01),冲击(0.45%对0.98%,OR0.467,p=0.02),并转移到其他医院设施(11.35%对14.78%,OR0.732,p<0.01)。肝性脑病或出血没有差异。此外,吸烟者从入院到手术的等待时间较短(2.76±0.09vs3.17±0.09天,p=0.01),住院时间较短(7.50±0.15vs9.89±0.21天,p<0.01),医院总费用较低(148,721±2,740.7vs204,911±4,683.5美元,p<0.01)。亚组分析显示,当前和过去吸烟者的模式一致。
结论:本研究比较了吸烟者和非吸烟者在接受TIPS手术后的直接结果。有趣的是,我们观察到了一个吸烟者的悖论,吸烟者在TIPS后有更好的结果。这种吸烟者悖论的根本原因值得进一步深入探索。
OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate patients with chronic liver cirrhosis and portal hypertension. Smoking can adversely impact liver function and has been shown to influence liver-related outcomes. This study aimed to examine the impact of smoking on the immediate outcomes of TIPS procedure.
METHODS: The study compared smokers and non-smokers who underwent TIPS procedures in the National Inpatient Sample (NIS) database from the last quarter of 2015 to 2020. Multivariable analysis was used to compare the in-hospital outcomes post-TIPS. Adjusted pre-procedural variables included sex, age, race, socioeconomic status, indications for TIPS, liver disease etiologies, comorbidities, and hospital characteristics.
RESULTS: Compared to non-smokers, smokers had lower risks of in-hospital mortality (7.36% vs 9.88 %, aOR 0.662, p < 0.01), acute kidney injury (25.57% vs 33.66 %, aOR 0.68, p < 0.01), shock (0.45% vs 0.98 %, aOR 0.467, p = 0.02), and transfer out to other hospital facilities (11.35% vs 14.78 %, aOR 0.732, p < 0.01). There was no difference in hepatic encephalopathy or bleeding. Also, smokers had shorter wait from admission to operation (2.76±0.09 vs 3.17±0.09 days, p = 0.01), shorter length of stay (7.50±0.15 vs 9.89±0.21 days, p < 0.01), and lower total hospital cost (148,721± 2,740.7 vs 204,911±4,683.5 US dollars, p < 0.01). Subgroup analyses revealed consistent patterns among both current and past smokers.
CONCLUSIONS: This study compared the immediate outcomes of smokers and non-smokers after undergoing the TIPS procedure. Interestingly, we observed a smokers\' paradox, where smoker patients had better outcomes following TIPS. The underlying causes for this smoker\'s paradox warrant further in-depth exploration.