Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization
Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization
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DOI：
10.1177/1358863x20952856
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发表时间：
2020-10-06
影响因子：
3.5
通讯作者：
Orion, Kristine C.
中科院分区：
文献类型：
--
作者：
Kim, Tanner, I;Brahmandam, Anand;Orion, Kristine C.
高效抗逆转录病毒疗法（HAART）的发展显着提高了人类免疫缺陷病毒（HIV）患者的预期寿命，但也导致了包括外周动脉疾病（PAD）在内的慢性疾病的增加。然而，接受下肢血运重建的艾滋病毒患者的趋势和结果尚不清楚。本研究的目的是调查国家数据库中 HIV 和 PAD 患者下肢血运重建的趋势和围手术期结果。 2003 年至 2014 年间对全国住院患者样本 (NIS) 进行了审查。所有诊断为 PAD 并接受下肢血运重建的入院患者均根据 HIV 状况进行分层。使用倾向评分匹配和多变量回归评估结果。在所有因PAD而接受下肢血运重建的患者中，HIV感染者的比例从2003年的0.21%显着增加到2014年的0.52%（p<0.01）。与未感染艾滋病毒的患者相比，感染艾滋病毒的患者在干预时更可能是年轻的男性，并且合并症较少，包括冠状动脉疾病和糖尿病。通过倾向评分匹配和多变量回归，艾滋病毒状况与住院总费用增加相关，但与住院时间、大截肢或死亡率无关。接受血运重建的 HIV 合并 PAD 患者年龄较小，合并症较少，但与未感染 HIV 的患者相比，医院费用增加。 PAD 下肢血运重建对于 HIV 患者来说是安全的，不会增加院内大截肢或死亡的风险，并且每年持续增加。
The development of highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with human immunodeficiency virus (HIV), but has led to the rise of chronic conditions including peripheral artery disease (PAD). However, trends and outcomes among patients with HIV undergoing lower extremity revascularization are poorly characterized. The aim of this study was to investigate the trends and perioperative outcomes of lower extremity revascularization among patients with HIV and PAD in a national database. The National Inpatient Sample (NIS) was reviewed between 2003 and 2014. All hospital admissions with a diagnosis of PAD undergoing lower extremity revascularization were stratified based on HIV status. Outcomes were assessed using propensity score matching and multivariable regression. Among all patients undergoing lower extremity revascularization for PAD, there was a significant increase in the proportion of patients with HIV from 0.21% in 2003 to 0.52% in 2014 (p< 0.01). Patients with HIV were more likely to be younger, male, and have fewer comorbidities, including coronary artery disease and diabetes, at the time of intervention compared to patients without HIV. With propensity score matching and multivariable regression, HIV status was associated with increased total hospital costs, but not length of stay, major amputation, or mortality. Patients with HIV with PAD who undergo revascularization are younger with fewer comorbidities, but have increased hospital costs compared to those without HIV. Lower extremity revascularization for PAD is safe for patients with HIV without increased risk of in-hospital major amputation or mortality, and continues to increase each year.