This retrospective cohort study used a national claims database spanning 2010–2023 to evaluate whether HIV-positive patients undergoing thoracic or lumbar fusion experience different rates of postoperative complications and revision procedures over 10 years compared with matched HIV-negative controls. The primary objective was to compare the 10-year risk of revision surgery and complication-related procedures. Short-term complications at 30 and 90 days were also assessed.
Investigators queried a large national administrative claims dataset containing over 170 million patients to identify individuals who underwent thoracic or lumbar fusion from 2010 through 2023. From this overall population, 3,538 patients with an HIV diagnosis who received fusion surgery were identified. Among these, 3,534 HIV-positive patients were successfully matched to 7,064 HIV-negative controls on a 2:1 basis using age, sex, and Charlson comorbidity index as matching variables. The report provides these overall cohort sizes and matching approach; additional granular patient-level characteristics beyond the matching variables were not detailed in the abstract.
Procedures were classified as either deformity fusion (defined as fusion of four or more levels) or degenerative fusion (fusion of fewer than four levels). Short-term outcomes included postoperative complications measured at 30 and 90 days. Long-term endpoints included all-cause revision surgery and other complication-related procedures tracked over a 10-year follow-up period. Time-to-event analyses employed Cox proportional hazards models to compare outcomes between HIV-positive and HIV-negative cohorts.
At 30 and 90 days after surgery, the HIV-positive cohort demonstrated lower observed rates of several complications compared with matched controls, specifically:
Conversely, the HIV-positive group had slightly increased rates of certain neurologic and thrombotic events, including:
The abstract reports these relative short-term differences but does not provide absolute incidence rates or detailed subgroup breakdowns within the summary.
Over the 10-year follow-up, no statistically significant differences were observed between HIV-positive patients and matched controls for key long-term surgical outcomes. Specifically, the hazard ratio for all-cause revision surgery in HIV-positive versus HIV-negative patients was reported as 0.96 (95% CI 0.75–1.22; P = 0.731), indicating no increased risk associated with HIV status in this analysis. The study also found no significant differences in rates of decompressive laminectomy or instrumentation removal between the cohorts over the follow-up period.
Time-to-event analyses were performed using Cox proportional hazards models to evaluate 10-year outcomes. The primary long-term comparison provided in the abstract is the hazard ratio for all-cause revision surgery (HR = 0.96; 95% CI 0.75–1.22; P = 0.731). The abstract does not report additional hazard ratios for individual complication-related procedures in the summary text.
The authors conclude that when HIV-positive status is well managed, it does not significantly increase the risk of short-term or long-term complications or the need for revision procedures following thoracic or lumbar fusion. Based on these findings, the authors argue that HIV infection alone should not be a reason to exclude patients from consideration for spinal fusion. This supports the surgical viability of thoracic and lumbar fusion in patients with HIV in contemporary practice.
The authors declare no conflicts of interest. The abstract does not report certain potentially relevant clinical details in the summary, such as individual patients’ antiretroviral therapy regimens, CD4 counts, viral load control, smoking status, or other behavioral and socioeconomic factors that could affect outcomes. Those details were not reported in the abstract and thus cannot be summarized here.
In a large matched cohort study using a national claims database, HIV-positive status—when presumably well managed—was not associated with higher 10-year risk of revision surgery or increased long-term complication-related procedures after thoracic or lumbar fusion compared with matched HIV-negative controls. Short-term risk profiles showed some lower rates of medical complications but modestly higher rates of thrombotic and neurologic events in the HIV-positive group. These results support offering spine fusion surgery to HIV-positive patients without categorically excluding them on the basis of HIV infection alone.