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

Qais Naziri, Matthew R. Boylan, Kimona Issa, Lynne C Jones, Harpal S Khanuja, Michael A. Mont

Research output: Contribution to journalArticle

Abstract

Background: Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA.

Results: Patients with HIV were more likely to be younger, be male, not pay with Medicare, and be of a nonwhite race. After controlling for confounding variables, patients with HIV were more likely to have major complications (2.9% [266 of 9275] versus 2.7% [71,952 of 2,656,696]; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08–2.00; p = 0.014) and minor complications (5.2% [483 of 9275] versus 4.8% [127,940 of 2,656,696]; OR, 1.61; 95% CI, 1.29–2.02; p 

Conclusions: Given these findings, we believe orthopaedic surgeons should be aware of the potential for longer and more complicated hospital stays after THA among patients with HIV. However, the modest increase in risk of adverse outcomes does not cause us to recommend against THA for patients with HIV who otherwise meet reasonable surgical indications. Future studies should explore the relationships between markers of HIV severity and risk of adverse outcomes after THA during the hospital stay and followup.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Questions/purposes: The purposes of this study were to assess (1) the demographic trends of patients with HIV who underwent primary THA; (2) the differences in the risk of major and minor perioperative complications among patients with and without HIV; and (3) the differences in mean length of hospital stay among patients with and without HIV.

Methods: The Nationwide Inpatient Sample was used to compare patients with and without HIV who were admitted for THA between 1998 and 2010 in the United States. We extracted data on each admission’s age, sex, race, insurance, and comorbidities. The study population consisted of 2,656,696 patients without HIV and 9275 patients with HIV.

Original languageEnglish (US)
Pages (from-to)581-586
Number of pages6
JournalClinical Orthopaedics and Related Research
Volume473
Issue number2
DOIs
StatePublished - 2014

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Virus Diseases
Arthroplasty
Hip
HIV
Databases
Length of Stay
Odds Ratio
Confidence Intervals
Confounding Factors (Epidemiology)
Medicare
Insurance
Comorbidity
Inpatients
Epidemiology
Demography
Guidelines

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study. / Naziri, Qais; Boylan, Matthew R.; Issa, Kimona; Jones, Lynne C; Khanuja, Harpal S; Mont, Michael A.

In: Clinical Orthopaedics and Related Research, Vol. 473, No. 2, 2014, p. 581-586.

Research output: Contribution to journalArticle

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title = "Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study",
abstract = "Background: Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA.Results: Patients with HIV were more likely to be younger, be male, not pay with Medicare, and be of a nonwhite race. After controlling for confounding variables, patients with HIV were more likely to have major complications (2.9{\%} [266 of 9275] versus 2.7{\%} [71,952 of 2,656,696]; odds ratio [OR], 1.47; 95{\%} confidence interval [CI], 1.08–2.00; p = 0.014) and minor complications (5.2{\%} [483 of 9275] versus 4.8{\%} [127,940 of 2,656,696]; OR, 1.61; 95{\%} CI, 1.29–2.02; p Conclusions: Given these findings, we believe orthopaedic surgeons should be aware of the potential for longer and more complicated hospital stays after THA among patients with HIV. However, the modest increase in risk of adverse outcomes does not cause us to recommend against THA for patients with HIV who otherwise meet reasonable surgical indications. Future studies should explore the relationships between markers of HIV severity and risk of adverse outcomes after THA during the hospital stay and followup.Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Questions/purposes: The purposes of this study were to assess (1) the demographic trends of patients with HIV who underwent primary THA; (2) the differences in the risk of major and minor perioperative complications among patients with and without HIV; and (3) the differences in mean length of hospital stay among patients with and without HIV.Methods: The Nationwide Inpatient Sample was used to compare patients with and without HIV who were admitted for THA between 1998 and 2010 in the United States. We extracted data on each admission’s age, sex, race, insurance, and comorbidities. The study population consisted of 2,656,696 patients without HIV and 9275 patients with HIV.",
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T1 - Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study

AU - Naziri, Qais

AU - Boylan, Matthew R.

AU - Issa, Kimona

AU - Jones, Lynne C

AU - Khanuja, Harpal S

AU - Mont, Michael A.

PY - 2014

Y1 - 2014

N2 - Background: Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA.Results: Patients with HIV were more likely to be younger, be male, not pay with Medicare, and be of a nonwhite race. After controlling for confounding variables, patients with HIV were more likely to have major complications (2.9% [266 of 9275] versus 2.7% [71,952 of 2,656,696]; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08–2.00; p = 0.014) and minor complications (5.2% [483 of 9275] versus 4.8% [127,940 of 2,656,696]; OR, 1.61; 95% CI, 1.29–2.02; p Conclusions: Given these findings, we believe orthopaedic surgeons should be aware of the potential for longer and more complicated hospital stays after THA among patients with HIV. However, the modest increase in risk of adverse outcomes does not cause us to recommend against THA for patients with HIV who otherwise meet reasonable surgical indications. Future studies should explore the relationships between markers of HIV severity and risk of adverse outcomes after THA during the hospital stay and followup.Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Questions/purposes: The purposes of this study were to assess (1) the demographic trends of patients with HIV who underwent primary THA; (2) the differences in the risk of major and minor perioperative complications among patients with and without HIV; and (3) the differences in mean length of hospital stay among patients with and without HIV.Methods: The Nationwide Inpatient Sample was used to compare patients with and without HIV who were admitted for THA between 1998 and 2010 in the United States. We extracted data on each admission’s age, sex, race, insurance, and comorbidities. The study population consisted of 2,656,696 patients without HIV and 9275 patients with HIV.

AB - Background: Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA.Results: Patients with HIV were more likely to be younger, be male, not pay with Medicare, and be of a nonwhite race. After controlling for confounding variables, patients with HIV were more likely to have major complications (2.9% [266 of 9275] versus 2.7% [71,952 of 2,656,696]; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08–2.00; p = 0.014) and minor complications (5.2% [483 of 9275] versus 4.8% [127,940 of 2,656,696]; OR, 1.61; 95% CI, 1.29–2.02; p Conclusions: Given these findings, we believe orthopaedic surgeons should be aware of the potential for longer and more complicated hospital stays after THA among patients with HIV. However, the modest increase in risk of adverse outcomes does not cause us to recommend against THA for patients with HIV who otherwise meet reasonable surgical indications. Future studies should explore the relationships between markers of HIV severity and risk of adverse outcomes after THA during the hospital stay and followup.Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Questions/purposes: The purposes of this study were to assess (1) the demographic trends of patients with HIV who underwent primary THA; (2) the differences in the risk of major and minor perioperative complications among patients with and without HIV; and (3) the differences in mean length of hospital stay among patients with and without HIV.Methods: The Nationwide Inpatient Sample was used to compare patients with and without HIV who were admitted for THA between 1998 and 2010 in the United States. We extracted data on each admission’s age, sex, race, insurance, and comorbidities. The study population consisted of 2,656,696 patients without HIV and 9275 patients with HIV.

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