Outcomes of Total Hip Arthroplasty in Human Immunodeficiency Virus-Positive Patients

Snir, Nimrod; Wolfson, Theodore; Schwarzkopf, Ran; Swensen, Stephanie; Alvarado, Carlos M.; Hamula, Mathew; Dayan, Alan

doi:10.1016/j.arth.2013.04.023

Cited by 28 publications

(18 citation statements)

References 48 publications

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“…In these studies, mean age has ranged from 45 to 50 years with the proportion of male patients ranging from 58% to 71% [10,11,17,18]. Our data for TKA patients are consistent with these previous studies, observing an average age of 52 years with 61% of admissions being male.…”

Section: Discussionsupporting

confidence: 94%

Does HIV Infection Increase the Risk of Short-Term Adverse Outcomes Following Total Knee Arthroplasty?

Boylan

Basu

Naziri

et al. 2015

The Journal of Arthroplasty

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Section: Discussionsupporting

confidence: 94%

Does HIV Infection Increase the Risk of Short-Term Adverse Outcomes Following Total Knee Arthroplasty?

Boylan

Basu

Naziri

et al. 2015

The Journal of Arthroplasty

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“…Mean age has ranged from 45 to 50 years with the proportion of male patients ranging from 58% to 71% [2,9,12,18]. Our study was consistent with these previous studies, observing an average age of 47 years with 83% of admissions being male.…”

Section: Discussionsupporting

confidence: 82%

“…Although the etiology of this relationship is unclear, metabolic, cardiovascular, and pulmonary comorbidities as well as the possible side effects of antiretroviral medications have been proposed as potential risk factors [1,4,8]. Two small studies assessing postoperative complications among admitted patients with HIV found an incidence of 12% among 41 THAs [18] and 13% among 55 lower extremity total joint arthroplasties [7]. Our data support these smaller existing studies and demonstrate that although patients with HIV have a higher risk of both major and minor complications during admission compared with patients without HIV, the chances of a complication occurring are still relatively modest.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have found that patients with HIV undergoing THA have a higher risk of developing perioperative complications [13,18]. Although the etiology of this relationship is unclear, metabolic, cardiovascular, and pulmonary comorbidities as well as the possible side effects of antiretroviral medications have been proposed as potential risk factors [1,4,8].…”

Section: Discussionmentioning

confidence: 99%

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Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study

Naziri

Boylan

Issa

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Those few studies that examined death often were underpowered to perform multivariate analyses. Some reports continued to show increased complications 22,23,44–50 and death 44,46,49 in patients with HIV infection, but others documented declining rates of surgical complications and deaths in the HIV infection group that rivaled those experienced by uninfected individuals across many surgical specialties including orthopedics, 51–57 cardiovascular surgery, 13,58–61 bariatric surgery, 62 transplant surgery, 16,24,63 obstetrics, 10,11,64 urologic surgery, 65 neurosurgery, 66 and general surgery. 12,14,15 …”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

et al. 2015

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IMPORTANCE Antiretroviral therapy (ART) has converted human immunodeficiency virus (HIV) infection into a chronic condition, and patients now undergo a variety of surgical procedures, but current surgical outcomes are inadequately characterized. OBJECTIVE To compare 30-day postoperative mortality in patients with HIV infection receiving ART with the rates in uninfected individuals. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of nationwide electronic medical record data from the US Veterans Health Administration Healthcare System, October 1, 1996, to September 30, 2010. Common inpatient surgical procedures were grouped using the Healthcare Cost and Utilization Project Clinical Classification System to match HIV-infected and uninfected patients in a 1:2 ratio. Data on 1641 patients with HIV infection receiving combination ART who were undergoing inpatient surgery were compared with data on 3282 procedure-matched, uninfected comparators. Poisson regression models of 30-day postoperative mortality were adjusted for procedure year, age, Charlson Comorbidity Index score, hemoglobin level, albumin level, HIV infection, CD4 cell count, and HIV-1 RNA level. MAIN OUTCOMES AND MEASURES All-cause 30-day postoperative mortality. RESULTS The most common procedures in both groups were cholecystectomy (10.5%), hip arthroplasty (10.5%), spine surgery (9.8%), herniorrhaphy (7.4%), and coronary artery bypass grafting (7.0%). In patients with HIV infection, CD4 cell distributions were 80.0% with 200/µL or more, 16.3% with 50/µL to 199/µL, and 3.7% with less than 50/µL; 74.1% of patients with HIV infection had undetectable HIV-1 RNA. Human immunodeficiency virus infection was associated with higher 30-day postoperative mortality compared with the mortality in uninfected patients (3.4% [56 patients]) vs 1.6% [53]); incidence rate ratio [IRR], 2.11; 95% CI, 1.41–3.17; P < .001). CD4 cell count was inversely associated with mortality, but HIV-1 RNA provided no additional information. After adjustment, patients with HIV infection had increased mortality compared with uninfected patients at all CD4 cell count strata (≥500/µL: IRR, 1.92; 95% CI, 1.02–3.60; P = .04; 200–499/µL: IRR, 1.89; 95% CI, 1.20–2.98; P = .01; 50–199/µL: IRR, 2.66; 95% CI, 1.29–5.47; P = .01; and <50/µL: IRR, 6.21; 95% CI, 3.55–10.85; P < .001). Hypoalbuminemia (IRR, 4.35; 95% CI, 2.78–6.81; P < .001) and age in decades (IRR, 1.47; 95% CI, 1.23–1.76; P < .001) were also strongly associated with mortality. CONCLUSIONS AND RELEVANCE Current postoperative mortality rates among individuals with HIV infection who are receiving ART are low and are influenced as much by hypoalbuminemia and age as by CD4 cell status. Human immunodeficiency virus infection and CD4 cell count are only 2 of many factors associated with surgical outcomes that should be incorporated into surgical decision making.

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Outcomes of Total Hip Arthroplasty in Human Immunodeficiency Virus-Positive Patients

Cited by 28 publications

References 48 publications

Does HIV Infection Increase the Risk of Short-Term Adverse Outcomes Following Total Knee Arthroplasty?

Does HIV Infection Increase the Risk of Short-Term Adverse Outcomes Following Total Knee Arthroplasty?

Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study

Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

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