Department of Surgery, Division of Vascular Surgery, Yale School of Medicine, New Haven, CT, USA.
Department of Surgery, Division of Vascular Diseases and Surgery, The Ohio State University School of Medicine, Columbus, OH, USA.
Vasc Med. 2020 Dec;25(6):527-533. doi: 10.1177/1358863X20952856. Epub 2020 Oct 6.
The development of highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with human immunodeficiency virus (HIV), but has led to the rise of chronic conditions including peripheral artery disease (PAD). However, trends and outcomes among patients with HIV undergoing lower extremity revascularization are poorly characterized. The aim of this study was to investigate the trends and perioperative outcomes of lower extremity revascularization among patients with HIV and PAD in a national database. The National Inpatient Sample (NIS) was reviewed between 2003 and 2014. All hospital admissions with a diagnosis of PAD undergoing lower extremity revascularization were stratified based on HIV status. Outcomes were assessed using propensity score matching and multivariable regression. Among all patients undergoing lower extremity revascularization for PAD, there was a significant increase in the proportion of patients with HIV from 0.21% in 2003 to 0.52% in 2014 ( < 0.01). Patients with HIV were more likely to be younger, male, and have fewer comorbidities, including coronary artery disease and diabetes, at the time of intervention compared to patients without HIV. With propensity score matching and multivariable regression, HIV status was associated with increased total hospital costs, but not length of stay, major amputation, or mortality. Patients with HIV with PAD who undergo revascularization are younger with fewer comorbidities, but have increased hospital costs compared to those without HIV. Lower extremity revascularization for PAD is safe for patients with HIV without increased risk of in-hospital major amputation or mortality, and continues to increase each year.
高效抗逆转录病毒疗法 (HAART) 的发展显著提高了人类免疫缺陷病毒 (HIV) 患者的预期寿命，但也导致包括外周动脉疾病 (PAD) 在内的慢性疾病的发病率上升。然而，HIV 患者下肢血运重建的趋势和结局特征描述较差。本研究旨在调查国家数据库中 HIV 合并 PAD 患者下肢血运重建的趋势和围手术期结局。回顾了 2003 年至 2014 年的国家住院患者样本 (NIS)。所有诊断为 PAD 并进行下肢血运重建的住院患者均根据 HIV 状况进行分层。使用倾向评分匹配和多变量回归评估结局。在所有因 PAD 接受下肢血运重建的患者中，HIV 患者的比例从 2003 年的 0.21%显著增加到 2014 年的 0.52%（<0.01）。与无 HIV 的患者相比，HIV 患者在介入时更年轻、更可能是男性，并且合并症更少，包括冠心病和糖尿病。经过倾向评分匹配和多变量回归分析，HIV 状况与总住院费用增加相关，但与住院时间、主要截肢或死亡率无关。与无 HIV 的患者相比，患有 PAD 的 HIV 患者更年轻，合并症更少，但住院费用更高。对于 HIV 合并 PAD 患者进行下肢血运重建是安全的，不会增加院内主要截肢或死亡率的风险，并且每年都在增加。
