The smoker's paradox in transjugular intrahepatic portosystemic shunt procedure: A national inpatient sample analysis from 2015 to 2020 - 29/03/24
Highlights |
• | The term "smoker's paradox" was originally coined in 1995 to denote the unexpected short-term mortality reduction seen in smokers following acute coronary syndrome. |
• | Our study is the first to identify this phenomenon in cirrhotic patients undergoing interventional radiology procedure Transjugular Intrahepatic Portosystemic Shunt (TIPS). |
• | Smoker patients had better outcomes including lower risk of in-hospital mortality, acute kidney injury, and shock. |
• | The underlying causes for this “smoker's paradox” warrant further in-depth exploration. |
Abstract |
Objectives |
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.
Materials and Method |
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.
Conclusion |
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.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Transjugular intrahepatic portosystemic shunt, Liver cirrhosis, Smoker's paradox
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Vol 48 - N° 5
Articolo 102323- Maggio 2024 Ritorno al numero
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