Assessing 10-Year Risk of Revision Surgery and Postoperative Complications Following Thoracic or Lumbar Fusion Surgery in HIV-Positive Patients.
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2025-09
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Abstract
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Retrospective cohort study.Objective
To evaluate the 10-year risk of revision surgery and postoperative complications in HIV-positive patients undergoing thoracic or lumbar fusion, compared to matched HIV-negative controls.Summary of background data
As HIV-positive patients live longer due to advancements in antiretroviral therapy, the prevalence of spinal degenerative and deformity-related conditions has risen. While prior studies suggest higher complication rates in HIV-positive individuals undergoing spine surgery, long-term outcomes following thoracic or lumbar fusion remain poorly characterized.Methods
A retrospective cohort analysis was performed using a national claims database of over 170 million patients (2010-2023). Patients who underwent thoracic or lumbar fusion were categorized into deformity fusion (≥4 levels) or degenerative fusion (<4 levels). HIV-positive patients were matched 2:1 with HIV-negative controls by age, gender, and Charlson Comorbidity Index. Complications were assessed at 30 and 90 days postoperatively. Long-term outcomes, including revision surgery and complication-related procedures, were evaluated over 10 years using Cox proportional hazards models.Results
A total of 3,538 HIV-positive patients and 903,713 controls were identified, with 3,534 HIV-positive patients matched to 7,064 controls. HIV-positive patients had lower rates of acute kidney injury, urinary tract infections, myocardial infarction, and infection at 30 and 90 days. However, they showed slightly increased rates of deep vein thrombosis, dysesthesia, and motor deficits. Over 10 years, no significant differences were observed in all-cause revision surgery (HR=0.96, 95% CI: 0.75-1.22, P=0.731), decompressive laminectomy, or instrumentation removal between cohorts.Conclusion
HIV-positive status, when well-managed, does not significantly increase the risk of short- or long-term complications or revision procedures after thoracic or lumbar fusion. These findings support the surgical viability of spinal fusion in HIV-positive patients and advocate against exclusion from operative care based solely on HIV status.Type
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Kishan, Arman, Harmon S Khela, Jeffrey Y Wang, Jeffrey Y Wang, Thomas P Cancian, Philip M Parel, Ethan J Cottrill, William C Eward, et al. (2025). Assessing 10-Year Risk of Revision Surgery and Postoperative Complications Following Thoracic or Lumbar Fusion Surgery in HIV-Positive Patients. Spine. 10.1097/brs.0000000000005524 Retrieved from https://hdl.handle.net/10161/33273.
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Scholars@Duke
William Curtis Eward
I am an Orthopaedic Oncologist, with dual clinical degrees (MD and DVM). I treat complex sarcomas in people and animals. My laboratory studies comparative oncology - discoveries we can make about cancer by analyses across different species.
Christopher Ignatius Shaffrey
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
Peter Passias
Throughout my medical career, I have remained dedicated to improving my patients' quality of life. As a specialist in adult cervical and spinal deformity surgery, I understand the significant impact our interventions have on individuals suffering from debilitating pain and physical and mental health challenges. Spinal deformity surgery merges the complexities of spinal biomechanics with the needs of an aging population. My research focuses on spinal alignment, biomechanics, innovative surgical techniques, and health economics to ensure value-based care that enhances patient outcomes.
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