Researchers find spine fusion is a realistic option for HIV-positive patients

They determined that in patients who underwent spine surgery, HIV infection was an independent risk factor for in-hospital mortality.

Despite having higher complication rates, a higher in-hospital mortality rate, and a longer hospital stay when compared with HIV-negative patients, the rate of HIV-positive patients undergoing spinal fusion procedures has increased over the past decade.

Hiroyuki Yoshihara, MD, PhD, first author of a study into spine fusion national trends and outcomes for HIV-positive patients, told Spine Surgery Today the rates were low and the clinical magnitude of the differences between the two groups of patients studied was often relatively small and therefore, he believes spinal fusion surgery is a reasonable option for HIV-positive patients.

Demographics and trends

Yoshihara and Daisuke Yoneoka, MS, conducted a retrospective analysis of spinal fusion data from procedures completed from 2000 to 2009 and derived from the U.S. Nationwide Inpatient Sample database. According to the study, 5,070 HIV-positive patients underwent spinal fusion in the United States during the study period.

Hiroyuki Yoshihara

They found the patients’ mean ages were 46.9 years for HIV-positive patients and 52.0 years for HIV-negative patients and there was a male-female ration of 77.9:22.1 for HIV-positive patients and 46.5:53.4 for HIV-negative patients. African American patients represented 23% of the HIV-positive patients and 5.6% of HIV-negative patients. In addition, the proportion of procedures performed at teaching hospitals was high form HIV-positive patients at 70.2% compared with 54.8% for HIV-negative patients.

During the study period, the number of HIV-positive patients who underwent spine fusion was 264 in 2000 and it increased to 930 in 2009. The rate of HIV-positive patients increased from 0.094 per 100,000 to 0.303 per 100,000 during that time.

Complication and mortality rates

According to the study, there were more respiratory and wound-related complications for HIV-positive patients when compared with HIV-negative patients undergoing spine fusions. Rates of pulmonary infection were 6.2% for HIV-positive patients and about half that, at 3.2%, for HIV-negative patients. The HIV-positive patients had wound-related complications at a rate of 2.7% compared to 1.7% in patients who were HIV-negative. The overall complication rate was higher for HIV-positive patients, as 12.2% of those patients developed some type of complication as opposed to 9.5% of patients without HIV who developed a complication.

However, there were fewer cardiac-related complications among HIV-positive patients, Yoshihara and Yoneoka noted in the study.

“The in-hospital mortality rate in the present study was more than 5 times higher in HIV-positive patients (1.6%) than in HIV-negative patients. In addition, logistic regression analysis revealed that HIV-positive patients have a 3.53 times higher risk of in-hospital mortality than HIV-negative patients. Thus, when counseling HIV-positive patients on spinal fusion procedures, these risks need to be discussed,” they wrote in the study.

LOS for HIV-positive patients

The length of hospital stay for HIV-positive patients was longer at an average of 6.6 days compared to an average length of stay of 4.2 days among patients who were HIV-negative.

Yoshihara told Spine Surgery Today, “Although numerous clinical parameters, such as complications and mortality, demonstrated statistically significant increases in HIV-positive patients, the clinical magnitude of these differences was relatively small. In addition, this study could not include parameters such as CD4 count and viral load. Therefore, I believe that spinal fusion is a reasonable option for HIV-positive patients, particularly for those with good HIV control.” – by Robert Linnehan

Reference:

Yoshihara H. Spine. 2014;doi:10.1097/BRS.0000000000000471.

For more information:

Hiroyuki Yoshihara, MD, PhD, can be reached at the Department of Orthopaedic Surgery, SUNY Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203; email: hiroyoshihara55@yahoo.co.jp.

Disclosure: Yoshihara has no relevant financial disclosures.