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

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 09 September 2014

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.

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.

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 < 0.001) compared with patients who did not have HIV. Patients undergoing THA who had HIV also had an increased length of hospital stay compared with patients without HIV (4.31 versus 3.83 days, p < 0.001).

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.

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Acknowledgments

We thank the HCUP Data Partners who contribute annually to the NIS. A full listing of participants can be found at <http://www.hcup-us.ahrq.gov/hcupdatapartners.jsp>.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Qais Naziri MD & Matthew R. Boylan BS

  2. Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Matthew R. Boylan BS

  3. Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, NJ, USA

    Kimona Issa MD

  4. Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Lynne C. Jones PhD & Harpal S. Khanuja MD

  5. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Michael A. Mont MD

Authors
  1. Qais Naziri MD
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  2. Matthew R. Boylan BS
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  3. Kimona Issa MD
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  4. Lynne C. Jones PhD
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  5. Harpal S. Khanuja MD
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  6. Michael A. Mont MD
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Corresponding author

Correspondence to Michael A. Mont MD.

Additional information

The institution of one or more of the authors has received or will receive, during the study period, funding from Stryker Orthopaedics (Mahwah, NJ, USA) (MAM), TissueGene (Rockville, MD, USA) (LCJ, MAM), Sage Products LLC (Cary, IL, USA) (MAM), Wright Medical Technology, Inc (Arlington, TN, USA) (MAM), Biocomposites Inc (Wilmington, NC, USA), Jannsen, Inc (Toronto, Ontario, Canada) (MAM), Joint Active Systems, Inc (Effingham, IL, USA) (MAM), Medtronic, Inc (Minneapolis, MN, USA) (MAM), Zimmer (Warsaw, IN, USA) (LCJ), and Johnson and Johnson (New Brunswick, NJ, USA) (LCJ).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

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Naziri, Q., Boylan, M.R., Issa, K. et al. Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study. Clin Orthop Relat Res 473, 581–586 (2015). https://doi.org/10.1007/s11999-014-3855-8

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  • DOI: https://doi.org/10.1007/s11999-014-3855-8

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