Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective
Objective: Human immunodeficiency virus infection (HIV+) is associated with a 2-fold increased risk of cardiovascular disease. Increasingly, patients who are HIV + are being evaluated to undergo cardiac surgery. Current risk-adjusted scoring systems, including the Society of Thoracic Surgeons Predic...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273624000032 |
| _version_ | 1797202977758380032 |
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| author | Ali Vaeli Zadeh, MD Alexander Justicz, MD Juan Plate, MD Michael Cortelli, MD I-wen Wang, MD, PhD John Nicholas Melvan, MD, PhD |
| author_facet | Ali Vaeli Zadeh, MD Alexander Justicz, MD Juan Plate, MD Michael Cortelli, MD I-wen Wang, MD, PhD John Nicholas Melvan, MD, PhD |
| author_sort | Ali Vaeli Zadeh, MD |
| collection | DOAJ |
| description | Objective: Human immunodeficiency virus infection (HIV+) is associated with a 2-fold increased risk of cardiovascular disease. Increasingly, patients who are HIV + are being evaluated to undergo cardiac surgery. Current risk-adjusted scoring systems, including the Society of Thoracic Surgeons Predicted Risk of Mortality score, fail to stratify HIV + risk. Unfortunately, there exists a paucity of cardiac surgery outcomes data in modern patients who are HIV+. Methods: We conducted a retrospective review of PearlDiver, an all-payer claims administrative database. In total, 14,714,743 patients were captured between 2010 and 2020. Of these, 59,695 (0.4%) of patients had a history of HIV+, and 1759 (2.95%) of these patients underwent cardiac surgery. Patients who were HIV+ were younger, more often male, and had greater comorbidity, history of hypertension, chronic obstructive pulmonary disease, chronic liver disease, chronic kidney disease, chronic lung disease, and heart failure. Results: Postoperatively, patients who were HIV + had significantly greater rates of pneumonia (relative risk, 1.70; P = .0003) and 30-day all-cause readmission (relative risk, 1.28, P < .0001). After linear regression analysis, these results remained significant. Data also show that a lesser proportion of patients with HIV + underwent coronary artery bypass grafting, aortic valve replacement, and any cardiac surgery compared with controls. Conclusions: Patients who are HIV + undergoing cardiac surgery are at greater risk of pneumonia and readmission. Moreover, we discovered lower rates of cardiac surgery in patients who are HIV+, which may reflect limited access to surgery when indicated. Today's risk-adjusted scoring systems in cardiac surgery need to better account for the modern patient who is HIV+. |
| first_indexed | 2024-04-24T08:12:01Z |
| format | Article |
| id | doaj.art-a065cf3923ab4e06bf0fb88f4e6cd696 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-24T08:12:01Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-a065cf3923ab4e06bf0fb88f4e6cd6962024-04-17T04:49:55ZengElsevierJTCVS Open2666-27362024-04-0118145155Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspectiveAli Vaeli Zadeh, MD0Alexander Justicz, MD1Juan Plate, MD2Michael Cortelli, MD3I-wen Wang, MD, PhD4John Nicholas Melvan, MD, PhD5Division of Cardiology, Holy Cross Hospital, Fort Lauderdale, FlaDivision of Cardiothoracic Surgery, Holy Cross Hospital, Fort Lauderdale, FlaDivision of Cardiac Surgery, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FlaDivision of Cardiac Surgery, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FlaDivision of Cardiac Surgery, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FlaDivision of Cardiothoracic Surgery, Holy Cross Hospital, Fort Lauderdale, Fla; Division of Cardiac Surgery, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, Fla; Address for reprints: John Nicholas Melvan, MD, PhD, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, 1150 N. 35th Ave, Suite 440, Hollywood, FL 33021.Objective: Human immunodeficiency virus infection (HIV+) is associated with a 2-fold increased risk of cardiovascular disease. Increasingly, patients who are HIV + are being evaluated to undergo cardiac surgery. Current risk-adjusted scoring systems, including the Society of Thoracic Surgeons Predicted Risk of Mortality score, fail to stratify HIV + risk. Unfortunately, there exists a paucity of cardiac surgery outcomes data in modern patients who are HIV+. Methods: We conducted a retrospective review of PearlDiver, an all-payer claims administrative database. In total, 14,714,743 patients were captured between 2010 and 2020. Of these, 59,695 (0.4%) of patients had a history of HIV+, and 1759 (2.95%) of these patients underwent cardiac surgery. Patients who were HIV+ were younger, more often male, and had greater comorbidity, history of hypertension, chronic obstructive pulmonary disease, chronic liver disease, chronic kidney disease, chronic lung disease, and heart failure. Results: Postoperatively, patients who were HIV + had significantly greater rates of pneumonia (relative risk, 1.70; P = .0003) and 30-day all-cause readmission (relative risk, 1.28, P < .0001). After linear regression analysis, these results remained significant. Data also show that a lesser proportion of patients with HIV + underwent coronary artery bypass grafting, aortic valve replacement, and any cardiac surgery compared with controls. Conclusions: Patients who are HIV + undergoing cardiac surgery are at greater risk of pneumonia and readmission. Moreover, we discovered lower rates of cardiac surgery in patients who are HIV+, which may reflect limited access to surgery when indicated. Today's risk-adjusted scoring systems in cardiac surgery need to better account for the modern patient who is HIV+.http://www.sciencedirect.com/science/article/pii/S2666273624000032HIVcardiac surgeryantiretroviralSTS PROMEuropean System for Cardiac Operative Risk Evaluation |
| spellingShingle | Ali Vaeli Zadeh, MD Alexander Justicz, MD Juan Plate, MD Michael Cortelli, MD I-wen Wang, MD, PhD John Nicholas Melvan, MD, PhD Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective JTCVS Open HIV cardiac surgery antiretroviral STS PROM European System for Cardiac Operative Risk Evaluation |
| title | Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective |
| title_full | Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective |
| title_fullStr | Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective |
| title_full_unstemmed | Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective |
| title_short | Human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgeryCentral MessagePerspective |
| title_sort | human immunodeficiency virus infection is associated with greater risk of pneumonia and readmission after cardiac surgerycentral messageperspective |
| topic | HIV cardiac surgery antiretroviral STS PROM European System for Cardiac Operative Risk Evaluation |
| url | http://www.sciencedirect.com/science/article/pii/S2666273624000032 |
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