Symptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery: A study of the nationwide inpatient sample

Abstract

BACKGROUND The impact of human immunodeficiency virus (HIV) infection on outcomes following common emergency general surgery procedures has not been evaluated since the widespread introduction of highly active antiretroviral therapy. METHODS A retrospective cohort study was conducted using the Nationwide Inpatient Sample. Records of patients who underwent laparoscopic or open appendectomy, cholecystectomy, or colon resection after emergency admission from 2004 to 2011 were obtained. Outcomes analyzed included in-hospital mortality, length of stay, total charges, and selected postoperative complications. Patients were divided among three groups, HIV-negative controls, asymptomatic HIV-positive patients, and symptomatic HIV/acquired immune deficiency syndrome (AIDS) patients. Data were analyzed using χ2 and multivariable regression with propensity score matching among the three groups, with p value less than 0.05 significant. RESULTS There were 974,588 patients identified, of which 1,489 were HIV-positive and 1,633 were HIV/AIDS-positive. The HIV/AIDS patients were more likely to die during their hospital stay than HIV-negative patients (4.4% vs. 1.6%, adjusted odds ratio, 3.53; 95% confidence interval [CI], 2.67–4.07; p < 0.001). The HIV/AIDS patients had longer hospital stays (7 days vs. 3 days; adjusted difference, 3.66 days; 95% CI, 3.53–4.00; p < 0.001) and higher median total charges than HIV-negative patients (US $47,714 vs. US $28,405; adjusted difference, US $15,264; 95% CI, US $13,905–US $16,623; p < 0.001). The HIV/AIDS patients also had significantly increased odds of certain postoperative complications, including sepsis, septic shock, pneumonia, urinary tract infection, acute renal failure and need for transfusion (p < 0.05 for each). Differences persisted irrespective of case complexity and over the study period. Asymptomatic HIV-positive patients had outcomes similar to HIV-negative patients. CONCLUSION The HIV/AIDS patients have a greater risk of death, infectious, and noninfectious complications after emergency surgery regardless of operative complexity and despite advanced highly active antiretroviral therapy. Patients who have not developed advanced disease, however, have similar outcomes to HIV-negative patients. LEVEL OF EVIDENCE Prognostic and epidemiologic study, level III.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

“…Sandler et al analyzed a large series of patients undergoing emergency surgery [ 138 ]. Their propensity score analysis compared HIV-positive patients without AIDS, AIDS patients, and HIV-negative patients.…”

Reducing Surgical Site Infections During Otolaryngology Surgical Missions

“…In addition, they had significantly increased odds of postoperative complications, including sepsis, septic shock, pneumonia, urinary tract infection, acute renal failure, and need for transfusion. This was not true of the asymptomatic HIV+ surgical patients in the same study . Less is known about LMIC and especially about head and neck surgery in the surgical mission setting.…”

Surgical management of appendicitis in patients with human immunodeficiency virus (HIV) positivity: a propensity score-matched analysis in a base hospital for HIV treatment in Japan

“…Some studies have shown that the postoperative complication rate of patients with well-controlled HIV infection is comparable to that of HIV (−) patients [ 21 – 24 ]. However, HIV infection is generally considered a surgical risk in terms of higher postoperative complications and longer hospital stays [ 3 ]. From the perspective of predicting the postoperative course, some studies have found that a low CD4 + lymphocyte count, especially < 200 cells/μL, was associated with a significant increase in postoperative complications after surgical intervention, including abdominal surgery [ 14 , 15 , 25 ].…”