Key result
In patients ≥65 years undergoing rotator cuff repair, HIV-positive status was associated with increased odds of 7-day myocardial infarction (OR 2.5), though the absolute risk was low (0.1%).
Why the study?
To examine postoperative complications associated with rotator cuff repair in HIV-positive patients aged 65 and older.
Does HIV-positive status increase the risk of postoperative complications following rotator cuff repair in patients ages 65 and older?
Cohort (n=152,114)
Yes
Does HIV-positive status increase the risk of postoperative complications following rotator cuff repair in patients ages 65 and older?
Odds Ratio: 2.5
Rotator cuff repair in HIV-positive patients aged 65 and older is associated with a slight increase in relative risk for postoperative complications like MI and heart failure, but the absolute risk remains very low, suggesting the procedure is generally safe.
Low absolute MI risk supports rotator cuff repair safety in most HIV-positive patients ≥65; leaves open causality and targeted risk mitigation.
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.
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Robinson et al. (2021) conducted a cohort in Rotator cuff repair (n=152,114). HIV-positive status vs. HIV-negative status was evaluated on 7-day myocardial infarction (OR 2.5). In patients ≥65 years undergoing rotator cuff repair, HIV-positive status was associated with increased odds of 7-day myocardial infarction (OR 2.5), though the absolute risk was low (0.1%).
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