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Disparities in Emergent Surgical Care in People Living with HIV
McKay J Meyer1,2, Savannah H Skidmore1,2, Heather L Evans3
1College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Insights
People living with HIV (PLWHIV) are less likely to receive timely surgical intervention for appendicitis and cholecystitis compared to HIV-negative individuals. This disparity highlights potential inequities in healthcare access and treatment for PLWHIV.
Area of Science:
- Surgical outcomes research
- Public health disparities
- Infectious disease epidemiology
Background:
- People living with HIV (PLWHIV) have historically faced healthcare access barriers and discrimination.
- Surgical emergencies like cholecystitis and appendicitis require timely intervention.
- Understanding surgical intervention rates in PLWHIV is crucial for addressing health inequities.
Purpose of the Study:
- To investigate disparities in surgical intervention rates for cholecystitis and appendicitis between PLWHIV and HIV-negative patients.
- To compare the rates of cholecystectomy and appendectomy in these patient groups.
- To identify potential differences in the management of common surgical emergencies.
Main Methods:
- Utilized the TriNetX® database for a retrospective cohort study.
- Included patients diagnosed with cholecystitis (K81) or appendicitis (K35-37) requiring surgical intervention.
- Propensity matched HIV-positive and HIV-negative cohorts based on age, race, leukocyte count, HIV viral load, and substance abuse disorders.
Main Results:
- HIV-positive patients with cholecystitis showed a lower risk of undergoing cholecystectomy (16.7% vs. 23.0%, RR 0.727).
- HIV-positive patients with appendicitis had a reduced risk of appendectomy (14.1% vs. 17.3%, RR 0.819).
- Both analyses revealed statistically significant differences (p < 0.0001 for cholecystectomy, p < 0.0031 for appendectomy).
Conclusions:
- This study demonstrates a significant disparity in surgical intervention for PLWHIV.
- PLWHIV experienced lower rates of cholecystectomy and appendectomy compared to their HIV-negative counterparts.
- Further research is needed to understand the causes and clinical implications of these disparities.
Abstract:
Introduction: People living with HIV (PLWHIV) have historically faced discrimination and unequal access to healthcare in the United States. This study aims to investigate differences in surgical intervention for common surgical emergencies among this population, specifically cholecystitis and appendicitis. Methods: This study utilized the TriNetX® database to compare the rate of cholecystectomies and appendectomies among PLWHIV with diagnosed cholecystitis or appendicitis, respectively, compared with HIV-negative patients. Inclusion criteria were an indication for surgical intervention, cholecystitis (K81) or appendicitis (K35-37). Cohorts were defined by HIV status, and analysis was stratified by procedure. Cohorts were propensity matched for age, race, leukocyte count, HIV 1 RNA volume, and substance abuse disorders. Outcomes were defined as patients receiving cholecystectomy or appendectomy in two separate analyses. Relative difference (RD) and relative risk (RR) were compared with between HIV+ and HIV- cohorts. Results: The cholecystectomy analysis had 609,127 total patients, with 3,597 per cohort after matching. The appendectomy analysis had 641,395 total patients, with 2,368 per cohort after matching. HIV-positive patients with cholecystitis had a 16.736% risk of undergoing cholecystectomy compared with 23.019% risk in HIV-cholecystitis patients (RD: -6.283% [95% confidence interval (95% CI): -8.122%, -4.444%], p < 0.0001, RR 0.727 [95% CI: 0.662, 0.799]). HIV-positive patients with appendicitis had a 14.147% risk of undergoing appendectomy compared with 17.272% in HIV-appendicitis patients (RD: -3.125%% [95% CI: -5.196%, -1.054%], p < 0.0031, RR 0.819, [95% CI 0.717, 0.935]). Conclusions: This study demonstrates a significant disparity in timely surgical intervention for PLWHIV. Further investigation is needed to elucidate the etiology of demonstrated incongruencies and their clinical relevance.
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