Journal article
Inpatient Outcomes After Elective Lumbar Spinal Fusion for Patients with Human Immunodeficiency Virus in the Absence of Acquired Immunodeficiency Syndrome
World neurosurgery, Vol.116, pp.e913-e920
08/2018
DOI: 10.1016/j.wneu.2018.05.128
PMID: 29852306
Abstract
To our knowledge, no prior study has evaluated outcomes after elective lumbar spinal surgery in human immunodeficiency virus (HIV) patients without acquired immunodeficiency syndrome (AIDS). This review investigated the impact of HIV-positive status (without AIDS) on outcomes after elective lumbar fusion for degenerative disc disease (DDD).
Adult patients registered in the Nationwide Inpatient Sample (2002–2011) undergoing elective lumbar fusion for DDD were extracted. Multivariable regression techniques were used to explore the association of HIV positivity with outcomes after lumbar fusion.
This cohort included 612,000 hospitalizations (0.07% were HIV positive) of lumbar fusion for DDD. Compared with HIV-negative patients undergoing lumbar fusion, HIV-positive patients were younger (47 vs. 55 years), male (61% vs. 42%), largely insured by Medicare (30% vs. 5%), and had higher rates of chronic obstructive pulmonary disease (23.7% vs. 14.6%) (all P < 0.001) but had lower rates of obesity, hypertension, and diabetes (all P < 0.001). Multivariable models demonstrated HIV positivity to be associated with higher odds for an adverse event (odds ratio [OR], 1.92; P < 0.001), in-hospital mortality (OR, 39.91; P < 0.001), wound complications (OR, 2.60; P = 0.004), respiratory (OR, 5.43; P < 0.001) and neurologic (OR, 1.96; P = 0.039) complications, and higher costs (7.1% higher; P = 0.011) compared with non-HIV patients. There were no differences in thromboembolic events, cardiac or gastrointestinal complications, discharge disposition, or length of stay.
Even in this selected cohort of well-controlled HIV patients, there were high complications, with concerning rates of death and respiratory complications. These data shed new light on elective spine surgery in HIV patients and may influence the treatment algorithm of surgeons who are familiar with older papers.
•HIV-positivity increseas the risk of postoperative wound and respiratory/neurologic complications and inpatient mortality.•Respiratory health should be maximized preoperatively and closely monitored in HIV patients.•HIV-positive patients have similar rates of thromboembolic events as HIV-negative patients.•HIV-positive patients have similar rates of cardiac and gastrointestinal complications as HIV-negative patients.•HIV-positive patients have similar rates of discharge disposition to home and length of stay as HIV-negative patients.
Details
- Title: Subtitle
- Inpatient Outcomes After Elective Lumbar Spinal Fusion for Patients with Human Immunodeficiency Virus in the Absence of Acquired Immunodeficiency Syndrome
- Creators
- Chester J. Donnally - University of Miami HospitalPiyush Kalakoti - University of IowaAndrew N.L. Buskard - University of MiamiAlexander J. Butler - University of Miami HospitalKarthik Madhavan - University of Miami HospitalAnil Nanda - Louisiana State University Health Sciences Center ShreveportAndrew J. Pugely - University of IowaJoseph P. Gjolaj - University of Miami Hospital
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.116, pp.e913-e920
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2018.05.128
- PMID
- 29852306
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Language
- English
- Date published
- 08/2018
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984303984402771
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