Rotator cuff repair in HIV-infected patients: an analysis of postoperative complications

OBJECTIVES: Human immunodeficiency virus (HIV) remains a major challenge to global health. However, advances in treatment have transformed HIV infection into a more manageable chronic disease, dramatically increasing the life expectancy of people living with HIV (PLWH). As a result, the range and extent of comorbidities in PLWH have expanded beyond infectious disease, and frequently involves the musculoskeletal system. HIV-positive patients may also suffer from rotator cuff pathology which may require surgical repair. The purpose of this study was to examine the postoperative complications associated with rotator cuff repair (RCR) in HIV-infected patients. METHODS: Data was collected from the Medicare Standardized Analytic Files between 2005 – 2015 using thePearlDiver Patient Records Database. Subjects were identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Demographics including age, sex, medical comorbidities, and smoking status were collected. Patients were stratified into two groups based upon a history of HIV diagnosis, with the non-infected group serving as the control. Potential confounders were mitigated using propensity score matching to create matched cohorts of patients with and without HIV infection undergoing RCR. Data on patient demographics, comorbidities, and postoperative complications were analyzed with univariate and multivariate analyses. Complications were examined at 7-, 30-, and 90-day postoperative time points. RESULTS: The study included 152,114 patients who underwent RCR, with 24,486 (16.1%) patients who were HIV-positive. Following univariate analysis, patients with HIV were observed to be more likely to develop 7-day, 30-day, and 90-day postoperative complications (Table 1). The multivariate analysis showed patients with HIV were more likely to develop myocardial infarction (OR: 2.494; 95% CI: 1.016-6.121; p<0.001) and sepsis (OR: 2.549; 95% CI: 1.085-5.938, p<0.001) within 7 days; acute renal failure (OR: 1.489; 95% CI: 1.015-2.186; p=0.041), postoperative anemia (OR:2.789; 95% CI: 1.732-4.493, p<0.001), atrial fibrillation (OR: 1.322; 95% CI: 1.079-1.619; p=0.006), blood transfusion (OR: 3.328; 95% CI: 2.005-5.536; p<0.001), heart failure (OR: 2.321; 95% CI: 1.805-2.983; p<0.001), pneumonia (OR: 3.452; 95% CI: 1.054-5.646; p=0.034), sepsis (OR: 2.654; 95% CI: 1.098-6.155; p<0.001), and stroke (OR: 2.007; 95% CI: 1.207-3.337; p=0.007) within 30 days; and mechanical complications (OR: 2.116; 95% CI: 1.232-3.634; p=0.006) and shoulder stiffness (OR: 1.395; 95% CI: 1.312-1.483; p=0.047) within 90 days following surgery (Table 1). CONCLUSION: To our knowledge, this study is the first to examine postoperative complications following RCR in HIV-infected patients. The rising life expectancy of PLWH has resulted in an increased need for orthopedic treatment of musculoskeletal disorders among HIV-positive individuals, including rotator cuff pathology. The findings of this study inform care regarding RCR in HIV-infected patients, enhancing the ability of practitioners to provide comprehensive care to individuals within this population. We found that complications following RCR occurred at increased rates in the HIV-infected group relative to the non-infected group. Surgeons should be aware PLWH are at elevated risk for postoperative complications in order to optimize care and proactively counsel patients.