This was a retrospective cohort studying using a national
The objective of this study was to determine the postoperative
complications and quality outcomes of the human immunodeficiency
virus (HIV)-positive patients undergoing surgical management for
lumbar degenerative disease (LDD).
This study identified patients with who underwent surgery for LDD
between 2007 and 2016. Patients were stratified based on whether
they were HIV positive at the time of surgery. Multivariate
regression was utilized to reduce the confounding of baseline
covariates. Patients who underwent 3 or more levels of surgical
correction were under the age of 18 years, or those with any prior
history of trauma or tumor were excluded from this study. Baseline
comorbidities, postoperative complication rates, and reoperation
rates were determined.
A total of 120,167 patients underwent primary lumbar degenerative
surgery, of which 309 (0.26%) were HIV positive. In multivariate
regression analysis, the HIV-positive cohort was more likely to be
readmitted at 30 days [odds ratio (OR)=1.9, 95% confidence interval
(CI): 1.2-2.8], 60 days (OR=1.7, 95% CI: 1.2-2.5), and 90 days
(OR=1.5, 95% CI: 1.0-2.2). The HIV-positive cohort was also more
likely to experience any postoperative complication (OR=1.7, 95% CI:
1.2-2.3). Of the major drivers identified, HIV-positive patients had
significantly greater odds of cerebrovascular disease and
postoperative neurological complications (OR=3.8, 95% CI: 1.8-6.9)
and acute kidney injury (OR=3.4, 95% CI: 1.3-7.1). Costs of index
hospitalization were not significantly different between the 2
cohorts ($30,056 vs. $29,720, P=0.6853). The total costs were also
similar throughout the 2-year follow-up period.
Patients who are HIV positive at the time of LDD surgery are at a
higher risk for postoperative central nervous system and renal
complications and unplanned readmissions.
Varshneya K, Wadhwa H, Ho A L, Medress Z A, Stienen M N, Desai A,
Ratliff J K, Veeravagu A. Surgical Outcomes of Human
Immunodeficiency Virus-positive Patients Undergoing Lumbar
Degenerative Surgery. Clin Spine Surg 2021;.