title: National trends and in-hospital outcomes in HIV-positive patients undergoing spinal fusion.
abstract: METHODS
  A retrospective analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.
  
  
  OBJECTIVE
  To examine the trends and in-hospital outcomes of patients with human immunodeficiency virus (HIV) infection undergoing spinal fusion on a national level.
  
  
  BACKGROUND
  Highly active antiretroviral therapy has provided healthier lives and prolonged the life expectancy of HIV-positive patients. However, few previous studies have reported trends and outcomes of HIV-positive patients undergoing spinal surgery.
  
  
  METHODS
  Clinical data were derived from the US Nationwide Inpatient Sample between 2000 and 2009. Patients who underwent spinal fusion were identified. Data regarding HIV, patient- and health care system-related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between HIV-positive and -negative patients and analyzed with the use of multivariate logistic regression.
  
  
  RESULTS
  A total of 5,070 HIV-positive patients underwent spinal fusion in the United States during the last decade. From 2000 to 2009, population-adjusted incidence of HIV-positive patients who underwent spinal fusion has increased more than 3-fold (0.094 per 100,000 in 2000 to 0.303 per 100,000 in 2009; P < 0.001). Comparison between HIV-positive and -negative patients showed that HIV-positive patients had a significantly higher respiratory complication rate (6.2% vs. 3.2%), wound-related complication rate (2.7% vs. 1.7%), overall in-hospital complication rate (12.2% vs. 9.5%), and in-hospital mortality rate (1.6% vs. 0.3%), as well as longer hospital stay (6.6 d vs. 4.2 d). The risk of in-hospital mortality was 3.53 times higher in HIV-positive patients after controlling for other factors (95% confidence interval, 2.02-6.14; P < 0.001).
  
  
  CONCLUSIONS
  During the last decade, the incidence of HIV-positive patients undergoing spinal fusion has increased in the United States. In this study, HIV infection was an independent risk factor for in-hospital mortality in patients undergoing spinal fusion.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY †Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and ‡Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoneoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006679:HIV Seropositivity; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000401:mortality / Q000639:trends*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult