Comorbidity in patients with HIV infection and tuberculous spondylitis as a risk factor for infectious complications
https://doi.org/10.14531/ss2020.1.96-101
Abstract
Objective. To determine how the presence of comorbidity, including the fact of the presence of HIV infection, affects the risks of developing infectious postoperative complications in patients with tuberculous spondylitis.
Material and Methods. A monocenter comparative retrospective analysis of 116 HIV-infected patients and 158 HIV-negative patients operated on for tuberculous spondylitis was carried out, with an analysis of risk factors for postoperative complications – concomitant diseases, the Charlson comorbidity index, the anesthesia-related and operative risk according to the ASA scale.
Results. Concomitant pathology and classes 3 and 4 according the ASA criteria were observed in 88.3 % of patients in the general cohort. In class 4 patients, infectious complications occurred 1.5 times more often, primarily due to early complications of immunodeficiency, while in the group of HIV-negative patients, the frequency of complications did not differ significantly between these classes. In HIV-infected patients with a moderately higher operative and anesthesia-related risk (risk increase factor = 1.19), the risk of postoperative complications increased by 1.76 times. Specific postoperative complications in HIV-infected patients were more common than in the control group (2 = 4.53, OR = 2.76).
Conclusion. The presence of HIV infection in patients with tuberculous spondylitis in comparison with HIV-negative patients is a risk factor that significantly increases the risk of early (occurring up to 1 year after surgery) postoperative complications, such as postoperative pneumonia, exacerbation (progression) of spondylitis and the development of tuberculous meningitis. At that, the risk of developing late postoperative complications does not depend on the fact of HIV infection.
Material and Methods. A monocenter comparative retrospective analysis of 116 HIV-infected patients and 158 HIV-negative patients operated on for tuberculous spondylitis was carried out, with an analysis of risk factors for postoperative complications – concomitant diseases, the Charlson comorbidity index, the anesthesia-related and operative risk according to the ASA scale.
Results. Concomitant pathology and classes 3 and 4 according the ASA criteria were observed in 88.3 % of patients in the general cohort. In class 4 patients, infectious complications occurred 1.5 times more often, primarily due to early complications of immunodeficiency, while in the group of HIV-negative patients, the frequency of complications did not differ significantly between these classes. In HIV-infected patients with a moderately higher operative and anesthesia-related risk (risk increase factor = 1.19), the risk of postoperative complications increased by 1.76 times. Specific postoperative complications in HIV-infected patients were more common than in the control group (2 = 4.53, OR = 2.76).
Conclusion. The presence of HIV infection in patients with tuberculous spondylitis in comparison with HIV-negative patients is a risk factor that significantly increases the risk of early (occurring up to 1 year after surgery) postoperative complications, such as postoperative pneumonia, exacerbation (progression) of spondylitis and the development of tuberculous meningitis. At that, the risk of developing late postoperative complications does not depend on the fact of HIV infection.
About the Authors
E. V. Shuvalova
St. Petersburg Research Institute of Phthisiopulmonology
Russian Federation
Russian Federation
Evgeniya Viktorovna Shuvalova, MD, PhD, orthopedic traumatologist, Spine center
32 Politekhnicheskaya str., St. Petersburg, 194064, Russia
A. A. Vishnevsky
St. Petersburg Research Institute of Phthisiopulmonology
Russian Federation
Russian Federation
Arkady Anatolyevich Vishnevsky, DMSc, leading researcher, neurosurgeon
32 Politekhnicheskaya str., St. Petersburg, 194064, Russia
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Review
For citations:
Shuvalova E.V., Vishnevsky A.A. Comorbidity in patients with HIV infection and tuberculous spondylitis as a risk factor for infectious complications. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2020;17(1):96-101. https://doi.org/10.14531/ss2020.1.96-101
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