Perioperative cesarean delivery morbidity among HIV-infected women under highly active antiretroviral treatment: a case-control study

Maiques, Vicente; García‐Tejedor, Amparo; Diago, Vicente; Molina, José Ma; Borras, Dolores; Perales‐Puchalt, Alfredo; Perales, Alfredo

doi:10.1016/j.ejogrb.2010.07.001

Cited by 12 publications

(12 citation statements)

References 35 publications

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“…Only a few more recent studies have focused on women receiving HAART. In two small studies comparing HIV-infected women to HIV-uninfected controls, the difference in major complications between the two groups (severe anemia, need for postpartum surgical procedures, pneumonia, peritonitis, sepsis, thrombosis, diffuse intravascular coagulation and subileus/ileus) was not significant [30,37], although one of the studies did find differences in minor complications (mild anemia, urinary tract infections, fever), the length of hospital stays, and blood loss [37]. Given that major complications are rare, these smaller studies were insufficiently powered to evaluate the comparative frequencies for the more severe outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…To identify women infected with HIV, we used ICD-9-CM codes: 042, 079.53, 279.10, 279.19, 795.71, 795.8, and V08 [36]. Patient age, primary expected payer (indicator of socioeconomic status), hospital teaching status/location, alcohol/substance abuse (ICD-9 codes 291–292, 303, 305, 648.3, 655.5, 965.0, V65.42), anemia (ICD-9 codes 648.2, 280–285), and diabetes (preexisting and gestational) (ICD-9 codes 250, 648.0, 648.8, 790.29, 791.5) were included as possible confounders, because they have been previously associated with complications related to cesarean delivery among HIV-infected women [19,30]. Race was not examined because it is often not reported by states or there are inconsistencies and missing values.…”

Section: Methodsmentioning

confidence: 99%

“…As there were very few thrombotic events, resulting in unstable estimates, these results are not presented. Multivariable logistic regression models were used to assess the odds of each complication for HIV-infected vs. HIV-uninfected women, adjusting for patient age, primary expected payer, hospital teaching status/location, anemia, diabetes, and alcohol/substance abuse [19,30]. …”

Section: Methodsmentioning

confidence: 99%

“…Although the studies upon which existing US guidelines were made demonstrate a clear benefit in reducing MTCT that outweighs potential risks of morbidity, most were conducted before the widespread use of HAART [21–23]. As maternal viral load is significantly associated with risk of MTCT [24–30], the additional benefit of scheduled cesarean delivery when full viral suppression has been achieved through the use of HAART has been questioned [31–33], and the US guidelines, as mentioned, do not recommend elective cesarean delivery in women with undetectable viral load [4,5]. …”

Section: Introductionmentioning

confidence: 99%

“…Given that perioperative morbidity associated with cesarean delivery is correlated with the degree of immunosuppression [9–13,17,30], the risks for morbidity may be lower for HIV-infected women on HAART. Furthermore, as any elevation in morbidity associated with cesarean deliveries needs to be balanced against benefits of preventing MTCT in the era of HAART, research is needed to assess the extent to which cesarean delivery continues to be associated with increased risk of complications.…”

Section: Introductionmentioning

confidence: 99%

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Complications of cesarean deliveries among HIV-infected women in the United States

Kourtis

Ellington

Pazol

et al. 2014

Aids

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Objective To compare rates of complications associated with cesarean delivery in HIV-infected and HIV-uninfected women in the United States and to investigate trends in such complications across four study cycles spanning the implementation of HAART in the United States (1995–1996, 2000–2001, 2005–2006, 2010–2011). Design The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project is the largest all-payer hospital inpatient care database in the United States; when weighted to account for the complex sampling design, nationally representative estimates are derived. After restricting the study sample to women aged 15–49 years, our study sample consisted of approximately 1 090 000 cesarean delivery hospitalizations annually. Methods Complications associated with cesarean deliveries were categorized as infection, hemorrhage, or surgical trauma, based on groups of specific International Classification of Diseases 9th revision codes. Length of hospitalization, hospital charges, and in-hospital deaths were also examined. Results The rate of complications significantly decreased during the study periods for HIV-infected and HIV-uninfected women. However, rates of infectious complications and surgical trauma associated with cesarean deliveries remained higher among HIV-infected, compared with HIV-uninfected women in 2010–2011, as did prolonged hospital stay and in-hospital deaths. Length of hospitalization decreased over time for cesarean deliveries of HIV-infected women to a greater extent compared with HIV-uninfected women. Conclusion In the United States, rates of cesarean delivery complications decreased from 1995 to 2011. However, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalization are still higher among HIV-infected women. Clinicians should remain alert to this persistently increased risk of cesarean delivery complications among HIV-infected women.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Complications of cesarean deliveries among HIV-infected women in the United States

Kourtis

Ellington

Pazol

et al. 2014

Aids

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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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Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000–2010

Briand

Jasseron

Sibiude

et al. 2013

American Journal of Obstetrics and Gynecology

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Perioperative cesarean delivery morbidity among HIV-infected women under highly active antiretroviral treatment: a case-control study

Cited by 12 publications

References 35 publications

Complications of cesarean deliveries among HIV-infected women in the United States

Complications of cesarean deliveries among HIV-infected women in the United States

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

Cesarean section for HIV-infected women in the combination antiretroviral therapies era, 2000–2010

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