HIV status was linked to more perioperative organ injury and higher in-hospital mortality in 41.6 million admissions

Design

Retrospective cohort, US National Inpatient Sample 2016 to 2021

Population

41,622,004 surgical admissions; 2,088,307 in people living with HIV

Primary outcome

Perioperative organ injury and in-hospital mortality

Effect

Organ injury 64.6% vs 19.9% (unadjusted); adjusted in-hospital mortality OR 1.66 (95% CI 1.54 to 1.78)

This retrospective cohort study used the US National Inpatient Sample from 2016 to 2021. Of 41,622,004 surgical admissions, 2,088,307 (5.0%) were in people living with HIV. These patients were older and had a much higher comorbidity burden (median Charlson index 8 against 1).

Unadjusted, perioperative organ injury occurred in 64.6% of people living with HIV against 19.9% of HIV-negative patients, with acute myocardial infarction (33.5%) and acute kidney injury (22.0%) the commonest injuries among those with HIV. In-hospital mortality was 3.2% against 2.2%. After adjustment for baseline characteristics and surgical complexity, HIV status was associated with higher in-hospital mortality (OR 1.66, 95% CI 1.54 to 1.78), longer stay (2.73 days more) and a lower chance of home discharge. Risk persisted in asymptomatic infection and was greatest in symptomatic disease or AIDS.

The data are administrative codes without CD4 count, viral load or treatment status, so residual confounding is likely, and the very high injury rates reflect coding rather than only clinical events. The authors suggest HIV status could be a risk variable in planning; the practical response is optimising comorbidity and communicating with the infection team.

• Adjusted in-hospital mortality was higher with HIV (OR 1.66, 95% CI 1.54 to 1.78).
• Myocardial infarction and acute kidney injury were the most frequent injuries in people with HIV.
• Risk was higher in symptomatic HIV or AIDS but persisted in asymptomatic infection.
• Review antiretroviral continuity, renal function and cardiovascular risk before surgery.
• Involve the HIV team in perioperative planning.

Why it matters

It suggests HIV is still a marker of perioperative risk despite effective treatment, but cannot say why.

Don't overread it

This is an administrative database study without viral load or CD4 data, so it does not show that HIV itself causes the extra risk.

The statistics, in plain English

An adjusted odds ratio of 1.66 means roughly two-thirds higher odds of dying in hospital after accounting for the variables measured. With 41 million records, tiny differences become statistically significant, and coded data cannot show how well the HIV was controlled.

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