HIV/AIDS patients undergoing total knee arthroplasty are at higher risk of acute renal failure and transfusion and incurred higher cost: a propensity-matched database study
Tóm tắt
Human immunodeficiency virus (HIV) is a retrovirus that can cause acquired immunodeficiency syndrome (AIDS). Total knee arthroplasty (TKA) in HIV-positive patients has not been well documented in the current literature. Thus, this study aimed to examine the early postoperative outcomes and complications of HIV-positive TKA patients as compared to TKA patients who are HIV-negative patients by utilizing the National Inpatient Sample (NIS) database. Admissions data for TKA and HIV were analyzed from the NIS database using ICD-10-CM diagnosis codes. An extensive array of preoperative and postoperative variables was compared among HIV positive TKA patients and HIV negative TKA patients. An unmatched analysis and a matched analysis using a 1:1 propensity match algorithm were conducted to compare the two groups. The average age of the HIV-positive group was lower than the HIV-negative group (59.0 vs 66.7, p < 0.001). The HIV-positive group had a smaller percentage of females (38.4% vs 61.5%, p < 0.001) and a lower incidence of tobacco-related disorders than the HIV-negative group (10.3% vs 15.8%, p = 0.032). The HIV-positive group had a longer mean length of stay (3.0 days vs 2.4 days, p < 0.001) and a greater mean total charge incurred (90,780.25 vs 64,801.55, p < 0.001). In the unmatched analysis, the incidence of acute renal failure (6.4% vs 2%, p < 0.001), transfusions (3.9% vs 1.5%, p = 0.004), and periprosthetic joint infection (3% vs 1%, p = 0.007) was higher in HIV positive group. The matched analysis showed a higher incidence of acute renal failure group (6.4% vs 0.5%, p = 0.01) and transfusions (3.9% vs 5%, p = 0.01) in the HIV-positive but a statistically insignificant difference in the rate of periprosthetic joint infection (3% vs 1%, p = 0.153). HIV/AIDS is associated with an increased incidence of acute renal failure and transfusions, as well as a longer length of stay and higher incurred costs in TKA patients.
Tài liệu tham khảo
Centers for Disease Control and Prevention. HIV Basics, Basic Statistics. Available at: https://www.cdc.gov/hiv/basics/statistics.html. Accessed March 2, 2021
Smiley CL, Rebeiro PF, Cesar C, Belaunzaran-Zamudio PF, Crabtree-Ramirez B, Padgett D, Gotuzzo E, Cortes CP, Pape J, Veloso VG, McGowan CC, Castilho JL, Caribbean, Central and South America network for HIV epidemiology (CCASAnet) (2021) Estimated life expectancy gains with antiretroviral therapy among adults with HIV in Latin America and the Caribbean: a multisite retrospective cohort study. Lancet HIV. 8(5):e266–e273. https://doi.org/10.1016/S2352-3018(20)30358-1
Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG (2017) Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med 18(4):256–266. https://doi.org/10.1111/hiv.12421 (Epub 2016 Aug 31 PMID: 27578404)
Liu Y, Foreman SC, Joseph GB, Neumann J, Tien PC, Li X, Lane NE, Nevitt MC, McCulloch CE, Link TM (2019) Is treated HIV infection associated with knee cartilage degeneration and structural changes? A longitudinal study using data from the osteoarthritis initiative. BMC Musculoskelet Disord 20(1):190. https://doi.org/10.1186/s12891-019-2573-5 (PMID:31054571; PMCID:PMC6500016)
O’Neill SC, Queally JM, Hickey A, Mulhall KJ (2019) Outcome of total hip and knee arthroplasty in HIV-infected patients: a systematic review. Orthop Rev (Pavia) 11(1):8020. https://doi.org/10.4081/or.2019.8020 (PMID:30996842; PMCID:PMC6452098)
HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2012. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp
Boylan MR, Basu N, Naziri Q, Issa K, Maheshwari AV, Mont MA (2015) Does HIV infection increase the risk of short-term adverse outcomes following total knee arthroplasty? J Arthroplasty 30(9):1629–1632. https://doi.org/10.1016/j.arth.2015.03.018 (Epub 2015 Mar 31 PMID: 25891433)
Roof MA, Anoushiravani AA, Chen KK, Moses MJ, Wolfson T, Poultsides L, Schwarzkopf R (2020) Outcomes of total knee arthroplasty in human immunodeficiency virus-positive patients. J Knee Surg 33(8):754–761. https://doi.org/10.1055/s-0039-1684011 (Epub 2019 Apr 8 PMID: 30959544)
Akkaya M, Buday Z, Akcaalan S, Linke P, Gehrke T, Citak M (2022) In-hospital complications following total knee and hip arthroplasty in patients with human immunodeficiency virus. Jt Dis Relat Surg 33(1):3–8. https://doi.org/10.52312/jdrs.2022.550 (Epub 2022 Mar 28 PMID: 35361074)
Lin CA, Kuo AC, Takemoto S (2013) Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. J Bone Joint Surg Am 95(11):1028–1036. https://doi.org/10.2106/JBJS.L.00269 (PMID: 23780541)
Kalyesubula R, Perazella MA (2011) Nephrotoxicity of HAART. AIDS Res Treat. 2011:562790. https://doi.org/10.1155/2011/562790 (Epub 2011 Aug 15. PMID: 21860787; PMCID: PMC3157198)
Falakassa J, Diaz A, Schneiderbauer M (2014) Outcomes of total joint arthroplasty in HIV patients. Iowa Orthop J 34:102–106 (PMID: 25328467; PMCID: PMC4127742)
Capogna BM, Lovy A, Blum Y, Kim SJ, Felsen UR, Geller DS (2013) Infection rate following total joint arthroplasty in the HIV population. J Arthroplasty 28(8):1254–1258. https://doi.org/10.1016/j.arth.2012.12.021 (Epub 2013 Mar 20 PMID: 23523495)
Enayatollahi MA, Murphy D, Maltenfort MG, Parvizi J (2016) Human immunodeficiency virus and total joint arthroplasty: the risk for infection is reduced. J Arthroplasty 31(10):2146–2151. https://doi.org/10.1016/j.arth.2016.02.058 (Epub 2016 Mar 10 PMID: 27131415)
Fan L, Li C, Zhao H (2020) Prevalence and risk factors of cytopenia in HIV-infected patients before and after the initiation of HAART. Biomed Res Int 28(2020):3132589. https://doi.org/10.1155/2020/3132589 (PMID:32090076; PMCID:PMC7008269)
Belperio PS, Rhew DC (2004) Prevalence and outcomes of anemia in individuals with human immunodeficiency virus: a systematic review of the literature. Am J Med 5(116 Suppl 7A):27S-43S. https://doi.org/10.1016/j.amjmed.2003.12.010 (PMID: 15050884)