Ethnoracial disparity in hospital survival following transjugular intrahepatic portosystemic shunt creation for acute variceal bleeding in the United States.

PURPOSE To investigate the magnitude of racial/ethnic differences in hospital mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation for acute variceal bleeding and whether hospital care processes contribute to them. METHODS Patients >18 years undergoing TIPS creation for acute variceal bleeding in the United States (n=10,331) were identified in the 10 available years (2007-2016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between patient race and inpatient mortality, controlling for disease severity, treatment utilization and hospital characteristics. RESULTS 6350 (62%) were White patients, 1780 (17%) were Hispanic patients and 482 (5%) were Black patients. A greater proportion of Black patients were admitted to urban teaching hospitals (n=409, 85% Black; n=1310, 74% Hispanic; n=4802, 76% White; p 0.05) to risk-adjusted mortality. CONCLUSIONS Black patients have two-fold higher inpatient mortality following TIPS creation for acute variceal bleeding, possibly related to greater disease pre-procedural severity, compared with non-Black patients.