Date of Award
Medical Doctor (MD)
Kevin M. Schuster
HIV-INFECTED PATIENTS HAVE POORER OUTCOMES FOLLOWING EMERGENCY GENERAL SURGERY: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE.
Britt J. Sandler, Kimberly A. Davis, Kevin M. Schuster. Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT.
The impact of HIV infection on surgical outcomes is not well understood in the era of highly-active antiretroviral therapy (HAART). This study was undertaken with the aim of characterizing the impact of HIV infection on outcomes following common emergency general surgery procedures.
A retrospective cohort study was conducted using the Nationwide Inpatient Sample. Records of patients who underwent laparoscopic or open appendectomy, cholecystectomy, or colon resection after emergency admission from 2004-2011 were obtained. Outcomes analyzed include in-hospital mortality, length of stay, total charges, and selected postoperative complications (sepsis, septic shock, pneumonia, surgical site infection (SSI), wound dehiscence, cardiac arrest, myocardial infarction, hemorrhage, blood transfusions, pulmonary embolism (PE), respiratory failure, urinary tract infection (UTI), and acute renal failure). Data were analyzed using chi-square and multivariable regression, with p <0.05 significant.
974,588 patients were identified. Of these, 3,122 were diagnosed with HIV. HIV-infected patients were more likely to die during their hospital stay than other patients (2.4% vs. 1.6%, adjusted OR = 2.42, 95% CI = 1.88-3.12, p<0.001). HIV-infected patients had longer hospital stays (7.5 vs. 5.5 days, adjusted difference = 1.7 days, 95% CI 1.53-1.91, p<0.001) and higher mean total charges than other patients ($59,179 vs. $44,498, adjusted difference = $12,624, 95% CI = $10,741-$14,507, p<0.001). HIV-infected patients also had significantly increased odds of certain post-operative complications, including sepsis, septic shock, PE, pneumonia, UTI, respiratory failure, and need for transfusion (p<0.05 for each). Differences persisted irrespective of case complexity and over the study period.
HIV-infected patients have a greater risk of death, infectious, and non-infectious complications after emergency surgery regardless of operative complexity. Despite advancing therapy for HIV it continues to negatively impact emergency surgery outcomes.
Sandler, Britt, "Hiv-Infected Patients Have Poorer Outcomes Following Emergency General Surgery: An Analysis Of The Nationwide Inpatient Sample" (2016). Yale Medicine Thesis Digital Library. 2077.