A. Chi1, B. E. Adams2, J. Sesti1, S. Paul1, A. Turner1, D. August1,3, D. Carpizo1,3, T. Kennedy1,3, M. Grandhi1,3, S. K. Libutti3, S. Geffner1, R. C. Langan1,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2United States Military Academy,Mathematical Sciences,West Point, NEW YORK, USA 3Rutgers Cancer Institute Of New Jersey,Surgical Oncology,New Brunswick, NJ, USA
Introduction: Human immunodeficiency (HIV) patients are now living longer due to the availability of antiretroviral therapies and non-AIDS defining cancers are becoming more prevalent in this patient population. However, a paucity of data remains on post-operative outcomes following resection of non-AIDS defining cancers in the HIV population.
Methods: The National Inpatient Sample was utilized to identify patients who underwent gastrectomy, hepatectomy, pancreatectomy, colectomy or pulmonary resection for malignancy from 2005 to 2015 (HIV, N=52,742; non-HIV, N=11,885,184). Complications were categorized by international classification of diseases (ICD)-9 diagnosis codes. The HIV and non-HIV cohorts were matched on type of insurance, household income, zip code and urban/rural setting. Logistic regression with the Survey Package in R was utilized to assess whether HIV was an independent predictor of post-operative complications. The analysis conducted took into account the sample trend weights and stratification to ensure inferences determined from the sample data are applicable to the population.
Results: Uncorrected data found HIV patients to have an increased rate of complications following colectomy, hepatic lobectomy, pulmonary resection (segmental and lobe), gastrectomy and distal pancreatectomy. However, univariate and multivariate logistic regression (Table 1) found HIV to only be an independent predictor of complications following pulmonary lobectomy (p=0.011; OR 2.93, 95% CI 1.29-6.73). There were no observed differences in post-operative mortality.
Conclusion: Our findings highlight the relative safety of major cancer surgery in the HIV population. HIV status should not exclusively be used to prohibit oncologic resections however; care providers need be cognizant of the potential increased risk of post-operative complications following pulmonary lobectomy. Future analysis is planned to further characterize the complications and assess length of stay. These findings are an initial insight into quality of care and outcome metrics on HIV patients undergoing major cancer operations and serve as a platform to assess whether HIV impacts other aspects of the continuum of care.
