McCarty Thomas R, Sharma Prabin, Lange Andrew, Ngu Julius N, Davis Ashley, Njei Basile
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Bariatr Surg Pract Patient Care. 2020 Sep 1;15(3):116-123. doi: 10.1089/bari.2019.0065. Epub 2020 Sep 14.
Despite rising rates of obesity among human immunodeficiency virus (HIV)-positive individuals, the safety and tolerability of surgery in this population have not been established. The primary aim of this study was to examine the safety of bariatric surgery and rate of in-hospital postoperative complications in morbidly obese patients with HIV. The U.S. Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with codiagnoses of morbid obesity and bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospitalization costs, and multiple categories of complications, including systemic complications, surgical complications, and nutritional and behavioral complications. Among 267,082 patients with discharge diagnoses of morbid obesity and bariatric surgery, 346 (0.13%) were diagnosed with HIV. On multivariable analysis, HIV did not influence in-hospital mortality ( = 0.530). HIV was not associated with increased risk of renal failure ( = 0.274), thromboembolism ( = 0.713), myocardial infarction ( = 0.635), sepsis ( = 0.757), hemorrhage ( = 0.303), or wound infection ( = 0.229). Other measured surgical complications were not significantly different ( > 0.05). Notably, HIV-positive patients had an increased risk for postoperative pneumonia ( = 0.002), pancreatitis ( = 0.049), and thiamine deficiency ( = 0.016). Bariatric surgery among HIV-positive patients appears to be acceptably safe with the risk of postoperative complications comparable with non-HIV patients.
尽管人类免疫缺陷病毒（HIV）阳性个体的肥胖率不断上升，但该人群手术的安全性和耐受性尚未确定。本研究的主要目的是检查肥胖症手术在HIV感染的病态肥胖患者中的安全性及术后住院并发症发生率。在2004年至2014年期间查询了美国全国住院患者样本数据库中伴有病态肥胖和肥胖症手术共诊断的出院病例。主要结局是住院死亡率。次要结局包括住院时间、住院费用以及多类并发症，包括全身并发症、手术并发症以及营养和行为并发症。在267,082例出院诊断为病态肥胖和肥胖症手术的患者中，346例（0.13%）被诊断为HIV感染。多变量分析显示，HIV感染不影响住院死亡率（P = 0.530）。HIV感染与肾衰竭风险增加无关（P = 0.274）、血栓栓塞（P = 0.713）、心肌梗死（P = 0.635）、脓毒症（P = 0.757）、出血（P = 0.303）或伤口感染（P = 0.229）。其他测量的手术并发症无显著差异（P>0.05）。值得注意的是，HIV阳性患者术后肺炎风险增加（P = 0.002）、胰腺炎（P = 0.049）和硫胺素缺乏（P = 0.016）。HIV阳性患者的肥胖症手术似乎具有可接受的安全性，术后并发症风险与非HIV患者相当。
