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Degenerative cervical myelopathy in HIV: Rates of postoperative complications and revision following decompression
Henry D Seidel1, Dillon Benson2, Audrey Litvak1
1University of Chicago, Pritzker School of Medicine, Chicago, IL, United States.
Insights
Patients with human immunodeficiency virus (HIV) undergo surgery for degenerative cervical myelopathy (DCM) at a younger age. While HIV patients have more short-term medical complications, revision and surgical complication rates are similar to non-HIV patients.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) is linked to cervical myelopathy.
- The impact of HIV on the timing of degenerative cervical myelopathy (DCM) surgery and long-term outcomes is not well understood.
- Investigating age at surgery and postoperative complication rates in HIV-positive patients with DCM is crucial.
Purpose of the Study:
- To determine the age of decompression surgery for degenerative cervical myelopathy (DCM) in patients with human immunodeficiency virus (HIV).
- To investigate the rates of postoperative complications and revision surgery in HIV-positive patients undergoing DCM decompression.
- To compare outcomes between HIV-positive and HIV-negative patients undergoing DCM surgery.
Main Methods:
- A national database was used to identify patients who underwent decompression surgery for DCM.
- Patients were stratified based on the presence of a pre-existing HIV diagnosis.
- Two-year rates of revision surgery, surgical complications, and 90-day medical complications were calculated and compared between groups.
Main Results:
- The study identified 1,014 HIV-positive patients and 153,974 HIV-negative patients.
- HIV-positive patients were significantly younger at the time of decompression surgery (53.6 vs. 57.1 years).
- No significant differences were found in 2-year revision rates or implant removal. However, HIV patients had higher 2-year infection rates and neurological deficits, along with increased 90-day medical complications like pneumonia, UTI, and renal failure.
Conclusions:
- Patients with HIV undergo decompression surgery for DCM at a younger age, though the clinical significance of this difference is uncertain.
- Despite higher short-term medical complication rates, HIV-positive patients do not experience increased rates of 2-year revision surgery or surgical complications requiring reoperation.
Background:
HIV has been associated with cervical myelopathy, but it is unclear if HIV leads to earlier presentation of DCM and need for decompression surgery. Furthermore, long-term rates of postoperative complications and revision following decompression surgery have not been investigated in this patient population. The aim of this study was to identify the age of surgery for degenerative cervical myelopathy (DCM) in patients with human immunodeficiency virus (HIV) and investigate postoperative revision and complication rates.
Methods:
Patients who underwent decompression surgery for DCM were identified in a national database and stratified by preexisting diagnosis of HIV. Demographic characteristics were identified. The 2-year rates of revision surgery, 2-year rates of postoperative surgical complications, and 90-day rates of postoperative medical complications were calculated.
Results:
1,014 patients with HIV and 153,974 patients without HIV were identified. The HIV group was younger at the time of decompression (53.6 ± 8.8; Non-HIV: 57.1 ± 11.0; p<.0001). There were no statistically significant differences in 2-year rates of revision (HIV: 7.6 %; Non-HIV 7.72 %; p=.88), removal of implants (HIV: 0.99 %; Non-HIV 1.06 %; p=.82), or I&D (HIV: 1.78 %; Non-HIV 1.31 %; p=.19). There were significant differences in the 2-year rates of infection diagnosis (HIV 4.93 %, non-HIV 3.59 %; p=.022) and neurological deficit (HIV 6.02 %, non-HIV 4.20 %; p<.001). 90-day medical complications of pneumonia, UTI, and renal failure were higher in the HIV group.
Conclusions:
Patients with HIV who develop cervical myelopathy undergo decompression at a younger age; this age difference may not be clinically significant. While patients with HIV are more likely to have higher rates of short-term medical complications, they do not experience higher 2-year rates of revision or surgical complications requiring reoperation.
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