Abstract
Advancements in human immunodeficiency virus (HIV) detection and treatment have prolonged the life expectancy of those infected with HIV. No prior study has evaluated elective lumbar spinal surgery in HIV patients or in those HIV patients whom have yet to developed autoimmune deficiency syndrome (AIDS).
The purpose of our study was to evaluate the effects of HIV-positive status in the absence of AIDS on demographics and rates of adverse events in patients undergoing elective lumbar fusion for degenerative disc disease. This study was based on the hypothesis was that in-hospital outcomes between asymptomatic HIV-positive and unaffected patients would be similar
Adult patients (>18 years) registered in the NIS that underwent an elective lumbar arthrodesis for degenerative disc disease were included. Patients were subsequently categorized into HIV-positive status and HIV-negative status patients. To determine the true effect of atymptomatic HIV, patients with manifestations of AIDS and other immune compromise were excluded.
Primary outcome measures were in-patient mortality, discharge disposition, short-term complications, length of hospital stay (LOS) and costs.
Clinical data on those who underwent lumbar spine fusion surgery for degenerative disc disease were collected from the 2002–2011 NIS. Fusions for trauma, cancer and infections, amongst others, were excluded to primarily select for elective procedures. Those with clinical manifestations of AIDS were also excluded. In-hospital outcomes were compared between asymptomatic HIV-positive patients versus uninfected patients and analyzed in a multivariable binary logistic regression model.
The HIV-positive group had more males (61.2% vs. 42.0%, p<.001), was younger (47.01+9.13years vs. 54.91+13.98years, p<.001), had higher rates of pre-existing COPD (23.7% vs. 14.6%, p<.001), yet had lower rates of obesity, hypertension and diabetes (p<.001). This cohort was characterized by a higher rate of any adverse postoperative event 14.2% versus 10.5% (p=.016), with significantly higher odds of adverse events (OR: 1.96), mortality (OR: 40.27), wound complications (OR: 2.60), respiratory complications (OR: 5.46) and neurologic complications (OR:1.98) (p<.005).
Our study was purposely limited to elective lumbar spine surgery in patients with “controlled HIV.” Contrary to current literature showing very high rates of complications, our selected cohort had considerably fewer complications than prior studies, with the concerning exception being death. This data sheds new light on elective spine surgery in HIV patients and may influence the treatment algorithm of surgeons who are familiar with the older manuscripts.