Authors: King JT Jr et al., JAMA Surg 2015 Feb 25;
Thirty-day mortality, although relatively low, was still higher than for HIV-uninfected patients.
Now that HIV-infected individuals have a near-normal life expectancy, they are increasingly likely to undergo surgical procedures. How do their short-term surgical outcomes compare with those of HIV-uninfected patients?
To answer this question, investigators studied 30-day mortality among HIV-infected patients on antiretroviral therapy (ART) who underwent major inpatient surgery and procedure-matched, uninfected controls in the Veterans Aging Cohort Study Virtual Cohort (n=1641 and 3282, respectively).
The HIV-infected cohort was primarily male (98.5%) with a median age of 54.3; 80.0% had a CD4 count ≥200 cells/mm3, and 74.1% had an undetectable viral load. The most common surgical procedures were cholecystectomy, hip arthroplasty, spine surgery, herniorrhaphy, and coronary artery bypass grafting.
Overall, 109 patients (2.2%) died ≤30 days after surgery, with mortality higher in those with HIV infection (3.4% vs 1.6%). In analyses confined to patients with HIV infection, lower CD4-cell counts, older age, and hypoalbuminemia were associated with higher mortality. At CD4 counts >500 cells/mm3, HIV-infected patients had mortality rates similar to those of uninfected patients; at counts <50 cells/mm3, however, mortality was markedly increased.
Although HIV-infected patients on ART generally do well with surgery, older age and perioperative characteristics such as low CD4-cell count and hypoalbuminemia play important roles in determining outcomes. However, none of these factors should be a reason to deny surgery for someone with HIV infection. Older age and poor nutrition are linked to higher mortality regardless of HIV status, and low CD4 counts are often not easily improved.
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