Changing prevalence, profile, and outcomes of patients with HIV undergoing cardiac surgery in the United States

Abstract

Objectives: Little is known about the prevalence, risk profile, and outcomes of patients with HIV undergoing cardiac surgery. This study was designed to evaluate clinical outcomes and national trends in this population in the United States.

Methods: Using data from the Nationwide Inpatient Sample from January 1, 2000, to December 31, 2010, prevalence, risk factors and clinical outcomes after cardiac surgery were quantified for patients with HIV. Cox proportional hazards models were used to evaluate the impact of HIV status on postoperative mortality, and weights used to estimate national trends.

Results: The prevalence of HIV in cardiac surgery patients doubled from 0.1% to 0.2% (P < .001), with 1,239 cases recorded out of a total of 810,940 over the study period. The proportion of HIV-positive patients undergoing cardiac surgery for endocarditis decreased from 31.8% to 8.2% (P = .016). Operative mortality in patients with HIV decreased from 5.6% to 0.87% (P < .001) over the study period. HIV was not found to be an independent predictor of operative mortality in multivariate analysis (adjusted OR 0.88, 95% CI 0.64-1.2, P = .436), whereas earlier year of operation (adjusted OR 0.72, 95% CI 0.60-0.87, P < .001) and the presence of disease conditions related to HIV status (OR 2.4, 95% CI 1.5-3.8, P = .01) were independent predictors of operative mortality in patients with HIV.

Conclusions: In contemporary practice HIV does not appear to be associated with incremental operative mortality, except in patients with clinical disorders related to their HIV status.