Spine - 2026-08-15 - Journal Article
Assessing 10-Year Risk of Revision Surgery and Postoperative Complications Following Thoracic or Lumbar Fusion Surgery in HIV-Positive Patients.
Kishan A, Khela HS, Wang JY, Cancian TP, Parel PM, Cottrill EJ, Eward WC, Shaffrey CI, Tahmasebpour P, Schoenfeld AJ, Kleck CJ, Avedian RS, Passias PG, Jankowski PP
Topics
Key Takeaway
HIV-positive patients undergoing thoracic or lumbar fusion showed no significant difference in 10-year all-cause revision surgery compared to matched controls (HR=0.96, 95% CI: 0.75–1.22).
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Summary
This study evaluated 10-year revision surgery rates and postoperative complications in HIV-positive patients undergoing thoracic or lumbar fusion versus 2:1 matched HIV-negative controls using a national claims database of >170 million patients. HIV-positive patients paradoxically showed lower rates of AKI, UTI, MI, and surgical site infection at 30 and 90 days, but slightly higher rates of DVT, dysesthesia, and motor deficits. No significant differences were found in all-cause revision surgery (HR=0.96), decompressive laminectomy, or instrumentation removal over 10 years.
Key Limitation
Claims-based data preclude stratification by CD4 count, viral load, or ART regimen, so it is unknown whether outcomes reflect well-controlled HIV universally or are driven by a subset of optimally managed patients.
Original Abstract
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To evaluate the 10-year risk of revision surgery and postoperative complications in HIV-positive patients undergoing thoracic or lumbar fusion, compared with matched HIV-negative controls.
SUMMARY OF BACKGROUND DATA
As HIV-positive patients live longer due to advancements in antiretroviral therapy, the prevalence of spinal degenerative and deformity-related conditions has risen. While prior studies suggest higher complication rates in HIV-positive individuals undergoing spine surgery, long-term outcomes following thoracic or lumbar fusion remain poorly characterized.
MATERIALS AND METHODS
A retrospective cohort analysis was performed using a national claims database of over 170 million patients (2010-2023). Patients who underwent thoracic or lumbar fusion were categorized into deformity fusion (≥4 levels) or degenerative fusion (<4 levels). HIV-positive patients were matched 2:1 with HIV-negative controls by age, gender, and Charlson comorbidity index. Complications were assessed at 30 and 90 days postoperatively. Long-term outcomes, including revision surgery and complication-related procedures, were evaluated over 10 years using Cox proportional hazards models.
RESULTS
A total of 3538 HIV-positive patients and 903,713 controls were identified, with 3534 HIV-positive patients matched to 7064 controls. HIV-positive patients had lower rates of acute kidney injury, urinary tract infections, myocardial infarction, and infection at 30 and 90 days. However, they showed slightly increased rates of deep vein thrombosis, dysesthesia, and motor deficits. Over 10 years, no significant differences were observed in all-cause revision surgery (HR=0.96, 95% CI: 0.75-1.22, P =0.731), decompressive laminectomy, or instrumentation removal between cohorts.
CONCLUSION
HIV-positive status, when well managed, does not significantly increase the risk of short- or long-term complications or revision procedures after thoracic or lumbar fusion. These findings support the surgical viability of spinal fusion in HIV-positive patients and advocate against exclusion from operative care based solely on HIV status.