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Does HIV infection increase the risk of perioperative complications after THA? A nationwide database study.

Abstract：

BACKGROUND:Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA. QUESTIONS/PURPOSES:The purposes of this study were to assess (1) the demographic trends of patients with HIV who underwent primary THA; (2) the differences in the risk of major and minor perioperative complications among patients with and without HIV; and (3) the differences in mean length of hospital stay among patients with and without HIV. METHODS:The Nationwide Inpatient Sample was used to compare patients with and without HIV who were admitted for THA between 1998 and 2010 in the United States. We extracted data on each admission's age, sex, race, insurance, and comorbidities. The study population consisted of 2,656,696 patients without HIV and 9275 patients with HIV. RESULTS:Patients with HIV were more likely to be younger, be male, not pay with Medicare, and be of a nonwhite race. After controlling for confounding variables, patients with HIV were more likely to have major complications (2.9% [266 of 9275] versus 2.7% [71,952 of 2,656,696]; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08-2.00; p=0.014) and minor complications (5.2% [483 of 9275] versus 4.8% [127,940 of 2,656,696]; OR, 1.61; 95% CI, 1.29-2.02; p<0.001) compared with patients who did not have HIV. Patients undergoing THA who had HIV also had an increased length of hospital stay compared with patients without HIV (4.31 versus 3.83 days, p<0.001). CONCLUSIONS:Given these findings, we believe orthopaedic surgeons should be aware of the potential for longer and more complicated hospital stays after THA among patients with HIV. However, the modest increase in risk of adverse outcomes does not cause us to recommend against THA for patients with HIV who otherwise meet reasonable surgical indications. Future studies should explore the relationships between markers of HIV severity and risk of adverse outcomes after THA during the hospital stay and followup. LEVEL OF EVIDENCE:Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

journal_name

Clin Orthop Relat Res

journal_title

Clinical orthopaedics and related research

authors

Naziri Q,Boylan MR,Issa K,Jones LC,Khanuja HS,Mont MA

doi

10.1007/s11999-014-3855-8

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

581-6

issue

eissn

0009-921X

issn

1528-1132

journal_volume

473

pub_type

杂志文章

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Does HIV infection increase the risk of perioperative complications after THA? A nationwide database study.