Trends Following Lumbar Spine Fusion in People Living With Human Immunodeficiency Virus in New York State

The population of individuals living with human immunodeficiency virus (HIV) is aging, resulting in increased rates of degenerative spinal conditions requiring surgical management. Limited literature exists comparing postoperative outcomes of lumbar spine fusion between patients with and without HIV, particularly for patients with CD4 counts higher than 200 (outside of AIDS diagnosis). This study evaluates perioperative complications, length of hospital stay, and discharge outcomes in HIV-positive versus HIV-negative patients following lumbar spine fusion in New York State.

A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative System (SPARCS) database, identifying adults undergoing lumbar spine fusion between 2016 and 2021. Patients were stratified by HIV status. Demographics, comorbidities, perioperative complications, mortality, and discharge status were compared using bivariate and multivariable regression analyses. SPARCS provided a composite complication measure was also recorded. Data are presented as n (%), means, and adjusted odds or incidence rate ratios where appropriate.

A total of 75,688 patients underwent lumbar spine fusion, including 526 (0.7%) with HIV and 75,162 (99.3%) without HIV. HIV-positive patients had a mean age of 57 years and were predominantly male (359, 68.3%), compared to the HIV-negative cohort (mean age: 57 years; 37,551, 50.0% male). HIV-positive patients had higher average comorbidities (2.76 vs. 2.04), more frequently experienced non-home discharge (285, 54.2% vs. 31,196, 41.5%), and had a longer mean length of stay (7.0 ± 11.3 days vs. 4.3 ± 5.9 days; p<0.001). The rate of composite index complications was similar (38, 7.2% in HIV-positive vs. 4,790, 6.4% in HIV-negative; p=0.426). The composite score created by SPARCS data encompasses complications such as embolism, renal failure, postoperative abscess, infection, and all-cause hospital mortality. Adjusted analyses confirmed that HIV-positive status was associated with increased length of stay (incidence rate ratio (IRR): 1.28, 95% CI: 1.21-1.36) and higher odds of non-home discharge (OR: 1.58, 95% CI: 1.32-1.89), but not increased complications or 30-day mortality.

HIV-positive patients undergoing lumbar spine fusion experience greater medical complexity and longer hospitalizations and are more frequently discharged to non-home settings than those without HIV. However, the overall rate of perioperative complications and short-term mortality does not differ significantly by HIV status. These findings support careful perioperative planning for HIV-positive individuals undergoing spine surgery to optimize outcomes.