Rotator cuff repair in HIV-positive patients ages 65 and older: only slight increase in risk of general postoperative surgical complications

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2021-12, Vol.29 (12), p.3971-3980
• Main Authors: Robinson, Neil M., Gu, Alex, Kaar, Scott G., Corey, Robert M., Bovonratwet, Patawut, Sculco, Peter K., Kim, Christopher
• Format: Article
• Language: English
• Subjects: Age; Anemia; Blood transfusion; Complications; Congestive heart failure; Demographics; Demography; Government programs; Heart attacks; Heart failure; HIV; Human immunodeficiency virus; Medicine; Medicine & Public Health; Multivariate analysis; Myocardial infarction; Older people; Orthopedics; Patients; Physicians; Postoperative; Postoperative period; Risk; Rotator cuff; Sepsis; Sexually transmitted diseases; Shoulder; Sports Medicine; STD; Terminology; Transfusion
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-021-06685-7

Purpose To examine postoperative complications associated with rotator cuff repair (RCR) in HIV-positive patients ages 65 and older. Methods Data were collected from the Medicare Standardized Analytic Files between 2005 and 2015 using the PearlDiver Patient Records Database. Subjects were selected using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Demographics including age, sex, medical comorbidities, and smoking status were collected. Complications were examined at 7-day, 30-day, and 90-day postoperative time points. Data were examined with univariate and multivariate analyses. 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. However, the absolute risk of each complication was quite low for HIV-positive patients. Univariate and multivariate analysis showed that within 7 days following surgery, patients with HIV were more likely to develop myocardial infarction (OR 2.5, AR 0.1%) and sepsis (OR 2.5, AR 0.04%). Within 30 days, HIV-positive patients were at increased risk for postoperative anemia (OR 2.8, AR 0.1%), blood transfusion (OR 3.3, AR 0.1%), heart failure (OR 2.3, AR 0.8%), and sepsis (OR 2.7, AR 0.1%). Within 90 days, mechanical complications (OR 2.1, AR 0.1%) were increased in the HIV-positive group. Conclusion Postoperative complications of RCR occurred at increased rates in the HIV-positive group compared to the HIV-negative group in patients ages 65 and older. In particular, increased risk for myocardial infarction, sepsis, heart failure, anemia, and mechanical complications was noted in HIV-positive patients. However, the actual percentage of patients who experienced each complication was low, indicating RCR is likely safe to perform even in older HIV-positive patients. As more older adults living with HIV present for elective orthopedic procedures, the results of the present study may reassure physicians who are considering RCR as an option for patients in this particular population, while also informing providers about potential complications. Level of evidence III.