The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
The George Washington University Hospital, Department of Interventional Radiology, Washington, DC, United State.
Clin Res Hepatol Gastroenterol. 2024 May;48(5):102323. doi: 10.1016/j.clinre.2024.102323. Epub 2024 Mar 26.
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.
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.
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.
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.
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静脉高压患者的手术。吸烟会对肝功能产生不利影响，并已被证明会影响与肝脏相关的结果。本研究旨在研究吸烟对 TIPS 术后即刻结果的影响。
本研究比较了 2015 年最后一个季度至 2020 年期间在国家住院患者样本（NIS）数据库中接受 TIPS 手术的吸烟者和不吸烟者。多变量分析用于比较 TIPS 术后住院期间的结果。调整后的术前变量包括性别、年龄、种族、社会经济状况、TIPS 适应证、肝病病因、合并症和医院特征。
与不吸烟者相比，吸烟者的住院死亡率（7.36% vs. 9.88%，aOR 0.662，p<0.01）、急性肾损伤（25.57% vs. 33.66%，aOR 0.68，p<0.01）、休克（0.45% vs. 0.98%，aOR 0.467，p=0.02）和转院至其他医院（11.35% vs. 14.78%，aOR 0.732，p<0.01）的风险较低。肝性脑病或出血无差异。此外，吸烟者从入院到手术的等待时间更短（2.76±0.09 天 vs. 3.17±0.09 天，p=0.01），住院时间更短（7.50±0.15 天 vs. 9.89±0.21 天，p<0.01），总住院费用更低（148721±2740.7 美元 vs. 204911±4683.5 美元，p<0.01）。亚组分析显示当前和过去吸烟者均存在一致的模式。
本研究比较了吸烟者和非吸烟者接受 TIPS 手术后的即刻结果。有趣的是，我们观察到了吸烟者悖论，即吸烟者在接受 TIPS 后有更好的结果。这种吸烟者悖论的根本原因需要进一步深入探讨。
