Elective Spinal Surgery in Asymptomatic HIV-Seropositive Persons

Young, William F.; Axelrod, Peter; Jallo, Jack

doi:10.1097/01.brs.0000151012.15510.57

Cited by 10 publications

(20 citation statements)

References 21 publications

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“…6 Young et al described improvement in five patients after surgery for degenerative spine disease with two minor complications (superficial infection, spontaneously resolving postoperative fever). 5 Larger studies are required to accurately establish the outcomes of elective spine surgery for degenerative spine disease in HIV infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…Spine surgery for degenerative spine disease has become increasingly common in the United States 3;4 and is the subject of numerous academic publications, yet there are few publications describing outcomes of spine surgery for degenerative disease in HIV infected individuals. 5;6 The low United States population prevalence of HIV infection (estimated at 0.4%) 7 complicates the study of surgical procedures in HIV positive patients – single institutions or even consortia may have insufficient numbers of HIV infected surgical patients to power meaningful analyses.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

King

Gordon²,

Perkal³

et al. 2012

Spine

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Study Design Retrospective analysis of nationwide Veterans Health Administration (VA) clinical and administrative data. Objective Examine the association between HIV infection and the rate of spine surgery for degenerative spine disease. Summary of Background Data Combination anti-retroviral therapy (cART) has prolonged survival in patients with HIV/AIDS, increasing the prevalence of chronic conditions such as degenerative spine disease that may require spine surgery. Methods We studied all HIV infected patients under care in the VA from 1996–2008 (n=40,038) and uninfected comparator patients (n=79,039) matched on age, gender, race, year, and geographic region. The primary outcome was spine surgery for degenerative spine disease defined by ICD-9 procedure and diagnosis codes. We used a multivariate Poisson regression to model spine surgery rates by HIV infection status, adjusting for factors that might affect suitability for surgery (demographics, year, comorbidities, body mass index, cART, and laboratory values). Results Two-hundred twenty eight HIV infected and 784 uninfected patients underwent spine surgery for degenerative spine disease during 700,731 patient-years of follow-up (1.44 surgeries per 1,000 patient-years). The most common procedures were spinal decompression (50%), and decompression and fusion (33%); the most common surgical sites were the lumbosacral (50%), and cervical (40%) spine. Adjusted rates of surgery were lower for HIV infected patients (0.86 per 1,000 patient-years of follow-up) than for uninfected patients (1.41 per 1,000 patient-years; IRR 0.61, 95% CI: 0.51, 0.74, P<0.001). Among HIV infected patients, there was a trend towards lower rates of spine surgery in patients with detectable viral loads levels (IRR 0.76, 95% CI: 0.55, 1.05, P=0.099). Conclusion In the VA, HIV infected patients experience significantly reduced rates of surgery for degenerative spine disease. Possible explanations include disease prevalence, emphasis on treatment of non-spine HIV-related symptoms, surgical referral patterns, impact of HIV on surgery risk-benefit ratio, patient preferences, and surgeon bias.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

King

Gordon²,

Perkal³

et al. 2012

Spine

View full text Add to dashboard Cite

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“…By contrast, complication rates were similar in minor operations, such as breast, cervical, or endoscopic procedures [22]. In reports on general and orthopaedic surgery, HIV‐seropositivity also does not appear to influence the complication rates of minor or non‐abdominal, elective procedures [7,26,27]. However, this differs in the setting of traumatic, emergency cases; in a large series of 476 patients with trauma, the wound infection rate was significantly higher in asymptomatic HIV‐infected patients than in uninfected patients [28].…”

Section: Discussionmentioning

confidence: 99%

Radical prostatectomy in patients infected with human immunodeficiency virus

et al. 2006

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OBJECTIVE To present the complications and early outcomes in a small series of men infected with human immunodeficiency virus (HIV) and treated with radical prostatectomy (RP) for prostate cancer, and to review reports on surgery in HIV‐positive patients. PATIENTS AND METHODS During 2002–2005, seven men infected with HIV underwent RP at our institution. For the five patients whose HIV status was known before surgery, we retrospectively examined preoperative variables, including HIV‐specific data (clinical category, CD4+ lymphocyte count, viral load, duration of HIV diagnosis, and opportunistic infections), and the complications and early outcomes after RP. RESULTS Before RP all the patients were in the Center for Disease Control clinical category A (asymptomatic HIV infection). The CD4+ counts before RP ranged from 269–870 cells/µL and viral loads ranged from <50–18 700 copies/mL. Three patients were on highly active anti‐retroviral therapy (HAART) at the time of surgery. After RP, two patients had incisional wound infections, including one requiring re‐hospitalization for intravenous antibiotics. During the follow‐up (median 26 months) none of the patients progressed to acquired immunodeficiency syndrome or developed biochemical recurrence of prostate cancer. One healthcare worker was exposed to contaminated urine and placed on prophylactic therapy, but has not sero‐converted. CONCLUSION The risk of peri‐operative complications in HIV‐positive patients can be minimized by carefully selecting the patient and procedure, and by measuring routine and HIV‐specific preoperative variables. The two infectious complications in this series were in patients with less favourable preoperative factors, i.e. the lowest CD4+ count and the highest viral load. Further experience is needed to determine whether the risk of surgical infections is higher in this cohort. However, our results are consistent with reports from other surgical specialities that surgery in asymptomatic HIV‐positive patients is safe and effective.

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“…Presently there is conflicting data on whether HIV or reduced CD4 count due to HIV increases the likelihood of infections in clean implant surgery [14]–[17], [7]. The dilemma about not knowing whether implant surgery is safe for HIV positive individuals, has led surgeons to believe that the risk of infection in HIV infected patients is too high.…”

Section: Introductionmentioning

confidence: 99%

Is There an Increased Risk of Post-Operative Surgical Site Infection after Orthopaedic Surgery in HIV Patients? A Systematic Review and Meta-Analysis

et al. 2012

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BackgroundThere is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and sought to determine if this risk is altered by antibiotic use beyond 24 hours.MethodsWe searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method.ResultsWe identified 18 cohort studies with 16 mainly small studies, addressing the subject. The pooled risk ratio of infection in the HIV patients when compared to non-HIV patients was 1.8 (95% Confidence Interval [CI] 1.3–2.4), in studies in Africa this was 2.3 (95% CI 1.5–3.5). In a sensitivity analysis the risk ratio was reduced to 1.4 (95% CI 0.5–3.8). The risk ratio of infection in patients receiving prolonged antibiotics compared to patients receiving antibiotics for up to 24 hours was 0.7 (95% CI 0.1–4.2).ConclusionsThe results may indicate an increased risk in HIV infected patients but these results are not robust and inconclusive after conducting the sensitivity analysis removing poor quality studies. There is need for larger good quality studies to provide conclusive evidence. To better develop surgical protocols, further studies should determine the effect of reduced CD4 counts, viral load suppression and prolonged antibiotics on the risk for infection.

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Elective Spinal Surgery in Asymptomatic HIV-Seropositive Persons

Abstract: Many physicians have held a nihilistic approach, when it comes to the treatment of HIV-positive persons. However, our results in this small series of patients suggest that spinal surgery may be appropriate and can be performed with acceptable outcomes in selected patients.

Cited by 10 publications

References 21 publications

Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

Radical prostatectomy in patients infected with human immunodeficiency virus

Is There an Increased Risk of Post-Operative Surgical Site Infection after Orthopaedic Surgery in HIV Patients? A Systematic Review and Meta-Analysis

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