Ifarraguerri Anna Maria, Malyavko Alisa, Stoll W Travis, Patel Shalin, Thakkar Savyasachi
Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA.
Department of Orthopaedic Surgery, Adult Reconstruction Division, Johns Hopkins University, Columbia, MD, USA.
J Spine Surg. 2021 Dec;7(4):475-484. doi: 10.21037/jss-21-84.
To our knowledge, no studies exist that evaluate the impact of human immunodeficiency virus (HIV) on long-term revision rates following lumbar fusion. This study aims to understand how HIV impacts 2-year revision rates and 90-day postoperative complication rates following primary lumbar fusion for degenerative spine conditions.
Data collection was done using PearlDiver Patient Records Database, a national insurance database from 2010-2019. Patients who underwent primary lumbar fusion for degenerative diseases were divided into a cohort of patients that are HIV positive (HIV), have asymptomatic HIV (AHIV), acquired immune deficiency syndrome (AIDS), and HIV-negative at the time of their procedure. Univariate and multivariable regression analyses were performed to determine rates of revision surgery, surgical site infection (SSI), neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies within two years of surgery as well as 90-day postoperative complications.
In total, 216,587 patients were included in this study. Of these, 631 patients (0.29%) had HIV including 502 patients (0.23%) with asymptomatic HIV and 129 patients (0.06%) with AIDS. Relative to the control cohort, patients with HIV had no difference in odds of two-year revision surgery, SSI, neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies. Patients with HIV did have increased odds of postoperative pneumonia (OR 1.592; 95% CI: 1.048-2.314; P=0.021). AIDS patients had greater odds of respiratory complications (OR 2.585; 95% CI: 1.075-5.264; P=0.017) and septic complications (OR 2.702; 95% CI: 1.122-5.514; P=0.013) 90-day postoperatively.
Our study found that HIV positive status did not significantly affect two-year revision rates compared to the control group. However, there is a higher rate of pneumonia and respiratory complications among HIV positive patients. Before deciding to proceed with surgical intervention in HIV positive individuals, surgeons must carefully consider each patient's specific diagnosis, comorbidities, and risk factors.
据我们所知，尚无研究评估人类免疫缺陷病毒（HIV）对腰椎融合术后长期翻修率的影响。本研究旨在了解HIV如何影响因退行性脊柱疾病行初次腰椎融合术后的2年翻修率和术后90天并发症发生率。
使用PearlDiver患者记录数据库进行数据收集，该数据库是一个涵盖2010 - 2019年的全国性保险数据库。因退行性疾病接受初次腰椎融合术的患者被分为HIV阳性患者队列（HIV）、无症状HIV患者队列（AHIV）、获得性免疫缺陷综合征（AIDS）患者队列以及手术时HIV阴性患者队列。进行单因素和多因素回归分析，以确定手术两年内的翻修手术率、手术部位感染（SSI）、神经并发症、感觉障碍、肠道/膀胱功能障碍和脊髓病发生率以及术后90天并发症发生率。
本研究共纳入216,587例患者。其中，631例患者（0.29%）感染HIV，包括502例无症状HIV患者（0.23%）和129例AIDS患者（0.06%）。与对照组相比，HIV患者在两年翻修手术、SSI、神经并发症、感觉障碍、肠道/膀胱功能障碍和脊髓病的几率上无差异。HIV患者术后肺炎的几率增加（OR 1.592；95% CI：1.048 - 2.314；P = 0.021）。AIDS患者术后90天发生呼吸并发症（OR 2.585；95% CI：1.075 - 5.264；P = 0.017）和脓毒症并发症（OR 2.702；95% CI：1.122 - 5.514；P = 0.013）的几率更高。
我们的研究发现，与对照组相比，HIV阳性状态并未显著影响两年翻修率。然而，HIV阳性患者的肺炎和呼吸并发症发生率较高。在决定对HIV阳性个体进行手术干预之前，外科医生必须仔细考虑每位患者的具体诊断、合并症和危险因素。
