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Outcomes of patients with human immunodeficiency virus infection undergoing cardiovascular surgery in the United States.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2014 Dec; Vol. 148 (6), pp. 3066-73. Date of Electronic Publication: 2014 Aug 04. - Publication Year :
- 2014
-
Abstract
- Introduction: Advances in highly active antiretroviral therapy have dramatically improved the lifespan of patients infected with human immunodeficiency virus (HIV). We sought to examine the impact of HIV status on outcomes in patients undergoing cardiovascular surgery.<br />Methods: We identified 5,621,817 patients who underwent coronary artery bypass graft (CABG), valve, aortic, or other cardiovascular surgery between 1998 and 2009 from the Nationwide Inpatient Sample. Of these, 9771 (0.17%) patients were seropositive for HIV. Using multivariable logistic regression modeling and 1:1 propensity-score matching, we determined the influence of HIV infection on outcomes.<br />Results: The percentage of HIV+ patients undergoing cardiovascular surgery increased significantly from 0.09% to 0.23%. HIV+ patients were more often male, black, younger than 55 years of age, and on Medicaid, and they were more likely to undergo valve and other cardiovascular surgeries, but less likely to have CABG. Among propensity-matched pairs, patients with HIV were at no increased risk for in-patient mortality. HIV+ patients were more likely to receive a blood transfusion and have any postoperative complication. Patients with HIV were less likely to have a postoperative stroke. Rates of pneumonia, renal complications, and wound infection were similar between the groups. The median length of stay and mean total cost were not different between the groups. Factors that predicted in-hospital death in HIV+ patients included metastatic cancer, coagulopathy, renal failure, and aortic, other, or combined surgical procedure.<br />Conclusions: Cardiovascular surgery can be performed safely on patients with HIV with no increased hospital mortality and only minimal increased need for blood transfusion.<br /> (Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Blood Transfusion
Cardiovascular Diseases diagnosis
Cardiovascular Diseases economics
Cardiovascular Diseases mortality
Chi-Square Distribution
Child
Child, Preschool
Female
HIV Infections diagnosis
HIV Infections economics
HIV Infections mortality
HIV Infections therapy
HIV Seropositivity
Hospital Costs
Hospital Mortality
Humans
Infant
Infant, Newborn
Length of Stay
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications mortality
Postoperative Complications therapy
Propensity Score
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States epidemiology
Young Adult
Cardiac Surgical Procedures adverse effects
Cardiac Surgical Procedures economics
Cardiac Surgical Procedures mortality
Cardiovascular Diseases surgery
HIV Infections epidemiology
Vascular Surgical Procedures adverse effects
Vascular Surgical Procedures economics
Vascular Surgical Procedures mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 148
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25173116
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2014.07.074