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National Trends and In-hospital Outcomes in HIV-Positive Patients Undergoing Spinal Fusion

Yoshihara, Hiroyuki, MD, PhD*,†; Yoneoka, Daisuke, MS

doi: 10.1097/BRS.0000000000000471
Epidemiology
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Study Design. A retrospective analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.

Objective. To examine the trends and in-hospital outcomes of patients with human immunodeficiency virus (HIV) infection undergoing spinal fusion on a national level.

Summary of Background Data. Highly active antiretroviral therapy has provided healthier lives and prolonged the life expectancy of HIV-positive patients. However, few previous studies have reported trends and outcomes of HIV-positive patients undergoing spinal surgery.

Methods. Clinical data were derived from the US Nationwide Inpatient Sample between 2000 and 2009. Patients who underwent spinal fusion were identified. Data regarding HIV, patient- and health care system–related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between HIV-positive and -negative patients and analyzed with the use of multivariate logistic regression.

Results. A total of 5,070 HIV-positive patients underwent spinal fusion in the United States during the last decade. From 2000 to 2009, population-adjusted incidence of HIV-positive patients who underwent spinal fusion has increased more than 3-fold (0.094 per 100,000 in 2000 to 0.303 per 100,000 in 2009; P < 0.001). Comparison between HIV-positive and -negative patients showed that HIV-positive patients had a significantly higher respiratory complication rate (6.2% vs. 3.2%), wound-related complication rate (2.7% vs. 1.7%), overall in-hospital complication rate (12.2% vs. 9.5%), and in-hospital mortality rate (1.6% vs. 0.3%), as well as longer hospital stay (6.6 d vs. 4.2 d). The risk of in-hospital mortality was 3.53 times higher in HIV-positive patients after controlling for other factors (95% confidence interval, 2.02–6.14; P < 0.001).

Conclusion. During the last decade, the incidence of HIV-positive patients undergoing spinal fusion has increased in the United States. In this study, HIV infection was an independent risk factor for in-hospital mortality in patients undergoing spinal fusion.

Level of Evidence: 3

During the last decade, the incidence of HIV-positive patients undergoing spinal fusion has increased in the United States. In this study, HIV infection was an independent risk factor for in-hospital mortality in patients undergoing spinal fusion.

*Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY

Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and

Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.

Address correspondence and reprint requests to Hiroyuki Yoshihara, MD, PhD, Department of Orthopaedic Surgery, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203; E-mail: hiroyoshihara55@yahoo.co.jp

Acknowledgment date: February 6, 2014. First Revision: May 20, 2014. Acceptance date: June 2, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins