Varshneya Kunal, Wadhwa Harsh, Ho Allen L, Medress Zachary A, Stienen Martin N, Desai Atman, Ratliff John K, Veeravagu Anand
Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
Clin Spine Surg. 2022 Mar 1;35(2):E339-E344. doi: 10.1097/BSD.0000000000001221.
This was a retrospective cohort studying using a national administrative database.
The objective of this study was to determine the postoperative complications and quality outcomes of the human immunodeficiency virus (HIV)-positive patients undergoing surgical management for lumbar degenerative disease (LDD).
This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether they were HIV positive at the time of surgery. Multivariate regression was utilized to reduce the confounding of baseline covariates. Patients who underwent 3 or more levels of surgical correction were under the age of 18 years, or those with any prior history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.
A total of 120,167 patients underwent primary lumbar degenerative surgery, of which 309 (0.26%) were HIV positive. In multivariate regression analysis, the HIV-positive cohort was more likely to be readmitted at 30 days [odds ratio (OR)=1.9, 95% confidence interval (CI): 1.2-2.8], 60 days (OR=1.7, 95% CI: 1.2-2.5), and 90 days (OR=1.5, 95% CI: 1.0-2.2). The HIV-positive cohort was also more likely to experience any postoperative complication (OR=1.7, 95% CI: 1.2-2.3). Of the major drivers identified, HIV-positive patients had significantly greater odds of cerebrovascular disease and postoperative neurological complications (OR=3.8, 95% CI: 1.8-6.9) and acute kidney injury (OR=3.4, 95% CI: 1.3-7.1). Costs of index hospitalization were not significantly different between the 2 cohorts ($30,056 vs. $29,720, P=0.6853). The total costs were also similar throughout the 2-year follow-up period.
Patients who are HIV positive at the time of LDD surgery are at a higher risk for postoperative central nervous system and renal complications and unplanned readmissions.
这是一项使用国家行政数据库的回顾性队列研究。
本研究的目的是确定接受腰椎退行性疾病（LDD）手术治疗的人类免疫缺陷病毒（HIV）阳性患者的术后并发症和质量结果。
本研究确定了2007年至2016年间接受LDD手术的患者。根据手术时是否为HIV阳性对患者进行分层。采用多变量回归来减少基线协变量的混杂影响。接受3级或以上手术矫正、年龄在18岁以下或有任何创伤或肿瘤病史的患者被排除在本研究之外。确定基线合并症、术后并发症发生率和再次手术率。
共有120167例患者接受了原发性腰椎退行性手术，其中309例（0.26%）为HIV阳性。在多变量回归分析中，HIV阳性队列在30天（比值比[OR]=1.9，95%置信区间[CI]：1.2 - 2.8）、60天（OR=1.7，95% CI：1.2 - 2.5）和90天（OR=1.5，95% CI：1.0 - 2.2）时更有可能再次入院。HIV阳性队列也更有可能发生任何术后并发症（OR=1.7，95% CI：1.2 - 2.3）。在确定的主要驱动因素中，HIV阳性患者发生脑血管疾病和术后神经并发症（OR=3.8，95% CI：1.8 - 6.9）以及急性肾损伤（OR=3.4，95% CI：1.3 - 7.1）的几率显著更高。两个队列的首次住院费用无显著差异（30056美元对29720美元，P = 0.6853）。在两年的随访期内，总费用也相似。
LDD手术时HIV阳性的患者术后发生中枢神经系统和肾脏并发症以及计划外再次入院的风险更高。
