Spine. 2014 Sep 15;39(20):1694-8.

National trends and in-hospital outcomes in HIV-positive patients undergoing spinal fusion.

Yoshihara H1,2,3, Yoneoka D4.

1Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, US.

2Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY, US.

3Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

4Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.



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.

PMID: 24921848



The patients’ mean ages were 46.9 years for HIV-positive patients and 52.0 years for HIV-negative patients and there was a male-female ration of 77.9:22.1 for HIV-positive patients and 46.5:53.4 for HIV-negative patients. African American patients represented 23% of the HIV-positive patients and 5.6% of HIV-negative patients. In addition, the proportion of procedures performed at teaching hospitals was high for HIV-positive patients at 70.2% compared with 54.8% for HIV-negative patients.

Despite having higher complication rates, a higher in-hospital mortality rate, and a longer hospital stay when compared with HIV-negative patients, the rate of HIV-positive patients undergoing spinal fusion procedures has increased over the past decade.

The in-hospital mortality rate in the present study was more than 5 times higher in HIV-positive patients than in HIV-negative patients. In addition, logistic regression analysis revealed that HIV-positive patients have a 3.53 times higher risk of in-hospital mortality than HIV-negative patients. Thus, when counseling HIV-positive patients on spinal fusion procedures, these risks need to be discussed.

Although numerous clinical parameters, such as complications and mortality, demonstrated statistically significant increases in HIV-positive patients, the clinical magnitude of these differences was relatively small. In addition, this study could not include parameters such as CD4 count and viral load. Therefore, we believe that spinal fusion is a reasonable option for HIV-positive patients, particularly for those with good HIV control.



Hiroyuki Yoshihara, MD, PhD

Assistant Professor

Department of Orthopaedic Surgery & Rehabilitation Medicine

SUNY Downstate Medical Center

450 Clarkson Ave., Brooklyn, NY 11203

Email: hiroyuki.yoshihara@downstate.edu



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