---
title: "10-Year Risk of Revision and Complications After Thoracic or Lumbar Fusion in HIV-Positive Patients"
id: "pubmed-41025691"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41025691"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41025691/"
doi: "10.1097/BRS.0000000000005524"
published_at: "2026-08-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# 10-Year Risk of Revision and Complications After Thoracic or Lumbar Fusion in HIV-Positive Patients
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41025691
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41025691/)
- **DOI:** [10.1097/BRS.0000000000005524](https://doi.org/10.1097%2FBRS.0000000000005524)
- **Published At:** 2026-08-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study type: retrospective cohort analysis of a national claims database covering 2010–2023. - Population: 3,538 identified **HIV-positive** patients undergoing thoracic or lumbar fusion; 3,534 matched to 7,064 HIV-negative controls (2:1 match) by age, sex, and Charlson comorbidity index. - Fusion categorization: deformity fusion (≥4 levels) versus degenerative fusion (<4 levels). - Short-term complications assessed at 30 and 90 days; long-term outcomes assessed over 10 years using Cox proportional hazards models. - Short-term findings: HIV-positive patients had lower rates of acute kidney injury, urinary tract infection, myocardial infarction, and infection at 30 and 90 days. - Other short-term findings: slightly higher rates of deep vein thrombosis, dysesthesia, and motor deficits in HIV-positive patients. - Long-term outcomes: over 10 years, no significant differences between cohorts for all-cause **revision surgery** (HR = 0.96, 95% CI 0.75–1.22, P = 0.731), decompressive laminectomy, or instrumentation removal. - Main conclusion: well-managed **HIV-positive** status was not associated with increased short- or long-term risk of complications or revision procedures after thoracic or lumbar fusion. - Clinical implication: results support offering spinal fusion to HIV-positive patients and argue against excluding patients from operative care based solely on HIV status. - Conflict of interest: authors report no conflicts. - Limitations: specific limitations (for example, detailed antiretroviral therapy status, CD4 counts, or viral load) were not reported in the summary abstract.
## Clinical Analysis & Structured Key Points
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Epub 2025 Sep 30. # Assessing 10-Year Risk of Revision Surgery and Postoperative Complications Following Thoracic or Lumbar Fusion Surgery in HIV-Positive Patients [Arman Kishan](https://pubmed.ncbi.nlm.nih.gov/?term=Kishan+A&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Harmon S Khela](https://pubmed.ncbi.nlm.nih.gov/?term=Khela+HS&cauthor_id=41025691)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-2 "University of Pennsylvania, Philadelphia, PA."), [Jeffrey Y Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+JY&cauthor_id=41025691)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-3 "The George Washington University School of Medicine and Health Sciences, Washington, DC."), [Thomas P Cancian](https://pubmed.ncbi.nlm.nih.gov/?term=Cancian+TP&cauthor_id=41025691)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-4 "The Johns Hopkins University School of Medicine, Baltimore, MD."), [Philip M Parel](https://pubmed.ncbi.nlm.nih.gov/?term=Parel+PM&cauthor_id=41025691)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-3 "The George Washington University School of Medicine and Health Sciences, Washington, DC."), [Ethan J Cottrill](https://pubmed.ncbi.nlm.nih.gov/?term=Cottrill+EJ&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [William C Eward](https://pubmed.ncbi.nlm.nih.gov/?term=Eward+WC&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Christopher I Shaffrey](https://pubmed.ncbi.nlm.nih.gov/?term=Shaffrey+CI&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Paritash Tahmasebpour](https://pubmed.ncbi.nlm.nih.gov/?term=Tahmasebpour+P&cauthor_id=41025691)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-5 "Department of Neurosurgery Surgery, Hoag Memorial Hospital, Newport Beach, CA."), [Andrew J Schoenfeld](https://pubmed.ncbi.nlm.nih.gov/?term=Schoenfeld+AJ&cauthor_id=41025691)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-6 "Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA."), [Christopher J Kleck](https://pubmed.ncbi.nlm.nih.gov/?term=Kleck+CJ&cauthor_id=41025691)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-7 "Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO."), [Raffi S Avedian](https://pubmed.ncbi.nlm.nih.gov/?term=Avedian+RS&cauthor_id=41025691)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-8 "Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA."), [Peter G Passias](https://pubmed.ncbi.nlm.nih.gov/?term=Passias+PG&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Pawel P Jankowski](https://pubmed.ncbi.nlm.nih.gov/?term=Jankowski+PP&cauthor_id=41025691)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#full-view-affiliation-5 "Department of Neurosurgery Surgery, Hoag Memorial Hospital, Newport Beach, CA.") Affiliations Expand ### Affiliations * 1 Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC. * 2 University of Pennsylvania, Philadelphia, PA. * 3 The George Washington University School of Medicine and Health Sciences, Washington, DC. * 4 The Johns Hopkins University School of Medicine, Baltimore, MD. * 5 Department of Neurosurgery Surgery, Hoag Memorial Hospital, Newport Beach, CA. * 6 Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA. * 7 Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO. * 8 Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA. * PMID: **41025691** * DOI: [ 10.1097/BRS.0000000000005524 ](https://doi.org/10.1097/brs.0000000000005524) Item in Clipboard # Assessing 10-Year Risk of Revision Surgery and Postoperative Complications Following Thoracic or Lumbar Fusion Surgery in HIV-Positive Patients Arman Kishan et al. Spine (Phila Pa 1976). 2026. Show details Display options Display options Format Abstract PubMed PMID Spine (Phila Pa 1976) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Spine+%28Phila+Pa+1976%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Spine+%28Phila+Pa+1976%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41025691/) . 2026 Aug 15;51(16):1188-1196. doi: 10.1097/BRS.0000000000005524. Epub 2025 Sep 30. ### Authors [Arman Kishan](https://pubmed.ncbi.nlm.nih.gov/?term=Kishan+A&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Harmon S Khela](https://pubmed.ncbi.nlm.nih.gov/?term=Khela+HS&cauthor_id=41025691)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-2 "University of Pennsylvania, Philadelphia, PA."), [Jeffrey Y Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+JY&cauthor_id=41025691)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-3 "The George Washington University School of Medicine and Health Sciences, Washington, DC."), [Thomas P Cancian](https://pubmed.ncbi.nlm.nih.gov/?term=Cancian+TP&cauthor_id=41025691)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-4 "The Johns Hopkins University School of Medicine, Baltimore, MD."), [Philip M Parel](https://pubmed.ncbi.nlm.nih.gov/?term=Parel+PM&cauthor_id=41025691)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-3 "The George Washington University School of Medicine and Health Sciences, Washington, DC."), [Ethan J Cottrill](https://pubmed.ncbi.nlm.nih.gov/?term=Cottrill+EJ&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [William C Eward](https://pubmed.ncbi.nlm.nih.gov/?term=Eward+WC&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Christopher I Shaffrey](https://pubmed.ncbi.nlm.nih.gov/?term=Shaffrey+CI&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Paritash Tahmasebpour](https://pubmed.ncbi.nlm.nih.gov/?term=Tahmasebpour+P&cauthor_id=41025691)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-5 "Department of Neurosurgery Surgery, Hoag Memorial Hospital, Newport Beach, CA."), [Andrew J Schoenfeld](https://pubmed.ncbi.nlm.nih.gov/?term=Schoenfeld+AJ&cauthor_id=41025691)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-6 "Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA."), [Christopher J Kleck](https://pubmed.ncbi.nlm.nih.gov/?term=Kleck+CJ&cauthor_id=41025691)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-7 "Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO."), [Raffi S Avedian](https://pubmed.ncbi.nlm.nih.gov/?term=Avedian+RS&cauthor_id=41025691)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-8 "Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA."), [Peter G Passias](https://pubmed.ncbi.nlm.nih.gov/?term=Passias+PG&cauthor_id=41025691)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-1 "Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC."), [Pawel P Jankowski](https://pubmed.ncbi.nlm.nih.gov/?term=Jankowski+PP&cauthor_id=41025691)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/41025691/#short-view-affiliation-5 "Department of Neurosurgery Surgery, Hoag Memorial Hospital, Newport Beach, CA.") ### Affiliations * 1 Department of Neurological and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC. * 2 University of Pennsylvania, Philadelphia, PA. * 3 The George Washington University School of Medicine and Health Sciences, Washington, DC. * 4 The Johns Hopkins University School of Medicine, Baltimore, MD. * 5 Department of Neurosurgery Surgery, Hoag Memorial Hospital, Newport Beach, CA. * 6 Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA. * 7 Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO. * 8 Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA. * PMID: **41025691** * DOI: [ 10.1097/BRS.0000000000005524 ](https://doi.org/10.1097/brs.0000000000005524) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Study design:** Retrospective cohort study. **Objective:** To evaluate the 10-year risk of revision surgery and postoperative complications in HIV-positive patients undergoing thoracic or lumbar fusion, compared with matched HIV-negative controls. **Summary of background data:** As HIV-positive patients live longer due to advancements in antiretroviral therapy, the prevalence of spinal degenerative and deformity-related conditions has risen. While prior studies suggest higher complication rates in HIV-positive individuals undergoing spine surgery, long-term outcomes following thoracic or lumbar fusion remain poorly characterized. **Materials and methods:** A retrospective cohort analysis was performed using a national claims database of over 170 million patients (2010-2023). Patients who underwent thoracic or lumbar fusion were categorized into deformity fusion (≥4 levels) or degenerative fusion (<4 levels). HIV-positive patients were matched 2:1 with HIV-negative controls by age, gender, and Charlson comorbidity index. Complications were assessed at 30 and 90 days postoperatively. Long-term outcomes, including revision surgery and complication-related procedures, were evaluated over 10 years using Cox proportional hazards models. **Results:** A total of 3538 HIV-positive patients and 903,713 controls were identified, with 3534 HIV-positive patients matched to 7064 controls. HIV-positive patients had lower rates of acute kidney injury, urinary tract infections, myocardial infarction, and infection at 30 and 90 days. However, they showed slightly increased rates of deep vein thrombosis, dysesthesia, and motor deficits. Over 10 years, no significant differences were observed in all-cause revision surgery (HR=0.96, 95% CI: 0.75-1.22, P =0.731), decompressive laminectomy, or instrumentation removal between cohorts. **Conclusion:** HIV-positive status, when well managed, does not significantly increase the risk of short- or long-term complications or revision procedures after thoracic or lumbar fusion. These findings support the surgical viability of spinal fusion in HIV-positive patients and advocate against exclusion from operative care based solely on HIV status. **Keywords:** HIV; cohort; comorbidity; disparities; lumbar; postoperative complications; reoperation; retrospective; risk factors; spinal fusion; thoracic; vertebrae. Copyright © 2025 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement The authors report no conflicts of interest. ## Similar articles * [ No Increased Risk of All-cause Revision up to 10 Years in Patients Who Underwent Bariatric Surgery Before Single-level Lumbar Fusion. ](https://pubmed.ncbi.nlm.nih.gov/39132871/) Kuyl EV, Gupta A, Parel PM, Quan T, Patel TC, Mesfin A.Kuyl EV, et al.Clin Spine Surg. 2025 Mar 1;38(2):E115-E121. doi: 10.1097/BSD.0000000000001669. Epub 2024 Aug 12.Clin Spine Surg. 2025.PMID: 39132871 * [ Risk of Postoperative Complications and Revision Surgery Following Robot-assisted Posterior Lumbar Spinal Fusion. ](https://pubmed.ncbi.nlm.nih.gov/32956252/) Yang DS, Li NY, Kleinhenz DT, Patel S, Daniels AH.Yang DS, et al.Spine (Phila Pa 1976). 2020 Dec 15;45(24):E1692-E1698. doi: 10.1097/BRS.0000000000003701.Spine (Phila Pa 1976). 2020.PMID: 32956252 * [ Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Complications Following Thoracic and/or Lumbar Spinal Fusion for Degenerative Spine Disease: A BMI-Stratified Retrospective Study. ](https://pubmed.ncbi.nlm.nih.gov/40905270/) Kishan A, Khela HS
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