Postoperative Mortality Among HIV-Infected Patients

Carlos del Rio, MD reviewing 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.

CITATION(S):

King JT Jr et al. Thirty-day postoperative mortality among individuals with HIV infection receiving antiretroviral therapy and procedure-matched, uninfected comparators. JAMA Surg 2015 Feb 25; [e-pub].