title: Does HIV infection increase the risk of perioperative complications after THA? A nationwide database study.
abstract: BACKGROUND
  Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA.
  
  
  OBJECTIVE
  The purposes of this study were to assess (1) the demographic trends of patients with HIV who underwent primary THA; (2) the differences in the risk of major and minor perioperative complications among patients with and without HIV; and (3) the differences in mean length of hospital stay among patients with and without HIV.
  
  
  METHODS
  The Nationwide Inpatient Sample was used to compare patients with and without HIV who were admitted for THA between 1998 and 2010 in the United States. We extracted data on each admission's age, sex, race, insurance, and comorbidities. The study population consisted of 2,656,696 patients without HIV and 9275 patients with HIV.
  
  
  RESULTS
  Patients with HIV were more likely to be younger, be male, not pay with Medicare, and be of a nonwhite race. After controlling for confounding variables, patients with HIV were more likely to have major complications (2.9% [266 of 9275] versus 2.7% [71,952 of 2,656,696]; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08-2.00; p=0.014) and minor complications (5.2% [483 of 9275] versus 4.8% [127,940 of 2,656,696]; OR, 1.61; 95% CI, 1.29-2.02; p<0.001) compared with patients who did not have HIV. Patients undergoing THA who had HIV also had an increased length of hospital stay compared with patients without HIV (4.31 versus 3.83 days, p<0.001).
  
  
  CONCLUSIONS
  Given these findings, we believe orthopaedic surgeons should be aware of the potential for longer and more complicated hospital stays after THA among patients with HIV. However, the modest increase in risk of adverse outcomes does not cause us to recommend against THA for patients with HIV who otherwise meet reasonable surgical indications. Future studies should explore the relationships between markers of HIV severity and risk of adverse outcomes after THA during the hospital stay and followup.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Boylan
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Jones
authors.forename: Harpal S
authors.initials: HS
authors.lastname: Khanuja
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology