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Impact of bariatric surgery in patients with HIV infection: a nationwide inpatient sample analysis, 2004-2014.

ABSTRACT: OBJECTIVE:Despite rising rates of obesity among patients with HIV, the potential role for weight loss surgery in this population remains less clear. The primary aim of this study was to evaluate the role of bariatric surgery on relevant clinical outcomes among hospitalized obese patients with HIV. DESIGN:Retrospective analysis using the United States Nationwide Inpatient Sample database from 2004 to 2014. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared with those without bariatric surgery. PATIENTS:Patients with discharge co-diagnoses of morbid obesity and HIV. INTERVENTION:Bariatric surgery. MAIN OUTCOME MEASURES:Primary outcome was in-hospital mortality. Secondary outcomes included renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, gastrointestinal strictures, micronutrient deficiency, length of stay, and hospitalization costs. RESULTS:Among 7803 patients with discharge diagnoses of HIV and morbid obesity, 346 patients (4.4%) had bariatric surgery. The proportion of bariatric surgery in obese patients with HIV initially declined by -0.10% per year from 2004 to 2009 (Ptrend?

SUBMITTER: Sharma P

PROVIDER: S-EPMC6126912 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Impact of bariatric surgery in patients with HIV infection: a nationwide inpatient sample analysis, 2004-2014.

Sharma Prabin P McCarty Thomas R TR Ngu Julius N JN O'Donnell Michael M Njei Basile B

AIDS (London, England) 20180901 14

<h4>Objective</h4>Despite rising rates of obesity among patients with HIV, the potential role for weight loss surgery in this population remains less clear. The primary aim of this study was to evaluate the role of bariatric surgery on relevant clinical outcomes among hospitalized obese patients with HIV.<h4>Design</h4>Retrospective analysis using the United States Nationwide Inpatient Sample database from 2004 to 2014. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived ...[more]

PMID: 30157083

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Project description:BackgroundSystematic screening and treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in presurgical patients would impose a significant cost burden; therefore, it is important to understand whether SDB is associated with worse postoperative outcomes. We sought to determine the impact of SDB on postoperative outcomes in patients undergoing four specific categories of elective surgery (orthopedic, prostate, abdominal, and cardiovascular). The primary outcomes were in-hospital death, total charges, and length of stay (LOS). Two secondary outcomes of interest were respiratory and cardiac complications.MethodsData were obtained from the Nationwide Inpatient Sample database. Regression models were fitted to assess the independent association between SDB and the outcomes of interest.ResultsThe cohort included 1,058,710 hospitalized adult patients undergoing elective surgeries between 2004 and 2008. SDB was independently associated with decreased mortality in the orthopedic (OR, 0.65; 95% CI, 0.45-0.95; P = .03), abdominal (OR, 0.38; 95% CI, 0.22-0.65; P = .001), and cardiovascular surgery groups (OR, 0.54; 95% CI, 0.40-0.73; P < .001) but had no impact on mortality in the prostate surgery group. SDB was independently associated with a small, but statistically significant increase in estimated mean LOS by 0.14 days (P < .001) and estimated mean total charges by $860 (P < .001) in the orthopedic surgery group but was not associated with increased LOS or total charges in the prostate surgery group. In the abdominal and cardiovascular surgery groups, SDB was associated with a significant decrease in adjusted mean LOS of 1.1 days and 0.35 days, respectively (P < .001 for both groups), and adjusted mean total charges of $3,814 and $4,592, respectively (P < .001 for both groups). SDB was independently associated with a significantly increased OR for emergent intubation and mechanical ventilation, noninvasive ventilation, and atrial fibrillation in all four surgical categories. Emergent intubation occurred significantly earlier in the postoperative course in patients with SDB. In the subgroup of patients requiring emergent intubation, LOS, total charges, pneumonias, and in-hospital death were significantly higher in those without SDB.ConclusionsIn this large national study, despite the increased independent association of SDB with postoperative cardiopulmonary complications, the diagnosis of SDB was not independently associated with an increased rate of in-hospital death. SDB had a mixed impact on LOS and total charges by surgical category.

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Impact of bariatric surgery in patients with HIV infection: a nationwide inpatient sample analysis, 2004-2014.

Publications

Impact of bariatric surgery in patients with HIV infection: a nationwide inpatient sample analysis, 2004-2014.

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