Shah Neil V, Lettieri Matthew J, Gedailovich Samuel, Kim David, Oad Madhu, Veenema Ryne J, Wolfert Adam J, Beyer George A, Wang Hanbin, Nunna Ravi S, Hollern Douglas A, Lafage Renaud, Challier Vincent, Merola Andrew A, Passias Peter G, Schwab Frank J, Lafage Virginie, Paulino Carl B, Diebo Bassel G
Department of Orthopedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA.
Department of Radiology, Nassau University Medical Center, Hempstead, NY 11550, USA.
J Clin Med. 2023 Feb 12;12(4):1458. doi: 10.3390/jcm12041458.
In the United States, nearly 1.2 million people > 12 years old have human immunodeficiency virus (HIV), which is associated with postoperative complications following orthopedic procedures. Little is known about how asymptomatic HIV (AHIV) patients fare postoperatively. This study compares complications after common spine surgeries between patients with and without AHIV. The Nationwide Inpatient Sample (NIS) was retrospectively reviewed from 2005-2013, identifying patients aged > 18 years who underwent 2-3-level anterior cervical discectomy and fusion (ACDF), ≥4-level thoracolumbar fusion (TLF), or 2-3-level lumbar fusion (LF). Patients with AHIV and without HIV were 1:1 propensity score-matched. Univariate analysis and multivariable binary logistic regression were performed to assess associations between HIV status and outcomes by cohort. 2-3-level ACDF ( = 594 total patients) and ≥4-level TLF ( = 86 total patients) cohorts demonstrated comparable length of stay (LOS), rates of wound-related, implant-related, medical, surgical, and overall complications between AHIV and controls. 2-3-level LF ( = 570 total patients) cohorts had comparable LOS, implant-related, medical, surgical, and overall complications. AHIV patients experienced higher postoperative respiratory complications (4.3% vs. 0.4%,). AHIV was not associated with higher risks of medical, surgical, or overall inpatient postoperative complications following most spine surgical procedures. The results suggest the postoperative course may be improved in patients with baseline control of HIV infection.
在美国，近120万12岁以上的人感染了人类免疫缺陷病毒（HIV），这与骨科手术后的并发症有关。对于无症状HIV（AHIV）患者术后的情况知之甚少。本研究比较了有和没有AHIV的患者在常见脊柱手术后的并发症。对2005年至2013年的全国住院患者样本（NIS）进行了回顾性分析，确定了年龄大于18岁且接受2 - 3节段颈椎前路椎间盘切除融合术（ACDF）、≥4节段胸腰椎融合术（TLF）或2 - 3节段腰椎融合术（LF） 的患者。将有AHIV和没有HIV的患者按1:1倾向评分匹配。进行单因素分析和多变量二元逻辑回归，以评估HIV状态与各队列结局之间的关联。2 - 3节段ACDF（共594例患者）和≥4节段TLF（共86例患者）队列显示，AHIV患者与对照组在住院时间（LOS）、伤口相关、植入物相关、医疗、手术及总体并发症发生率方面具有可比性。2 - 3节段LF（共570例患者）队列在住院时间、植入物相关、医疗、手术及总体并发症方面具有可比性。AHIV患者术后呼吸系统并发症发生率较高（4.3%对0.4%）。在大多数脊柱手术中，AHIV与术后医疗、手术或总体住院并发症的较高风险无关。结果表明，对HIV感染进行基线控制的患者术后病程可能会得到改善。
