TIPS Outcomes According to Race and Ethnicity

Abstract

Introduction: Previous studies reported mortality rates of approximately 10% for the transjugular intrahepatic portosystemic shunt (TIPS) procedure. The purpose of this study was to evaluate TIPS outcomes according to race and ethnicity. Methods: TIPS procedures in adults (≥18 years) from 2012 to 2014 in the National Inpatient Sample (NIS) database were identified by ICD-9 procedure code 39.1. Patient and hospital characteristics were captured and 95% confidence intervals were constructed accounting for the complex survey design. Chi-squared and Student's t-tests were performed for categorical and continuous variables, respectively. Predictors of mortality with TIPS were assessed by mediation regression analysis. In-hospital mortality was the primary outcome. Since post-procedure length of stay (LOS) likely impacts mortality, it was considered as a mediating variable in the analysis. A log transformation was performed on post-procedure LOS to improve normality. Age, gender, indication, hospital bed size, primary payor, admission type and race were included as covariates in the model. Results: From 2012 to 2014, 18,320 (95% CI, 17,377-19,263) TIPS cases were identified; 70.9% (95% CI, 69.1-72.8) were non-elective. Overall in-hospital mortality was 9.7% (95% CI 8.8, 10.7). Elective TIPS had lower in-hospital mortality at 4.2% (95% CI, 3.1-5.4) compared to 12.0% (95% CI, 10.8-13.3) in non-elective cases. Baseline characteristics and outcomes by race and ethnicity are presented in the table; differences according to race/ethnicity were observed for age, sex, admission type, payor, and hospital size. In-hospital mortality in blacks was 19.4% (95% CI, 14.3, 24.5) compared to 8.9% (95% CI, 7.8, 10.1) in whites. Among non-elective cases, in-hospital mortality was 25.5% (95% CI, 19.1-31.9) for blacks and 10.9% (95% CI, 9.4-12.4) for whites. By regression analysis controlling for other variables in the model, the odds ratio of in-hospital mortality was 2.60 (95% CI, 1.81-3.72) for blacks compared to whites. Older age, indication of variceal bleed, longer post procedure LOS, and non-elective procedure status were associated with increased mortality. Conclusion: Black patients had increased risk of in-hospital mortality compared to other racial and ethnic groups after TIPS creation, even when controlling for elective versus non-elective procedure status. Further research is needed to understand the underlying reason(s) for increased risk of in-hospital mortality in black patients after TIPS.895 Figure 1 No Caption available.