Concomitant HIV/AIDS Infection Worsens Clinical Outcomes in Patients with Acute Diverticulitis

Author(s):
Tiago Finco; Bishoy Zakhary; Xiaofei Zhang; Megan Brenner; Raul Coimbra

Background:

Patients with HIV/AIDS can be predisposed to increased morbidity from common acute surgical diseases such as acute diverticulitis (AD).

Hypothesis:

Patients with AD and HIV/AIDS have worse clinical outcomes than AD patients without HIV/AIDS.

Methods:

The Nationwide Inpatient Sample (NIS) database was queried from 2012-2014. AD patients were abstracted from the database and divided into the following groups: no HIV/AIDS (NoH/A), HIV, and AIDS. These cohorts were further classified based on treatment for AD: lap colectomy (LC), open colectomy (OC) and no colectomy (NoC). Clinical outcomes including mortality, hospital length of stay (HLOS), cost, and surgery-related infections were compared between groups. Chi Squared Analysis and ANOVA were used for comparison for categorical and continuous dependent variables.

Results:

A total of 234,575 patients with AD were identified: 234,366 NoH/A, 50 HIV, and 159 AIDS. Overall, mean age (± SD) was 65 (± 16) years and most patients were female (56.9%). The majority of AD patients were White, while the majority of patients with AD and HIV/AIDS were Black (41.6%). There was no difference in mortality across treatment groups in patients with HIV. Treatment with OC in patients with AIDS resulted in a significantly higher mortality rate than NoC [16.7% vs 2.3%; p = 0.003]. Patients in the NoH/A group also had a higher mortality rate if treated with OC than NoC (3.9% versus 1.2%, p < 0.05). Sepsis was significantly higher in OC vs NC across all three groups (p < 0.001). Additionally, in patients with AD and AIDS, rates of pneumonia and PE/DVT were both higher in OC vs NoC (p = 0.001). Patients who underwent LC or OC had a longer HLOS and higher cost than NoC across all groups (p < 0.001).

Conclusions:

Patients treated surgically for AD incur a higher financial burden than those managed non-operatively, regardless of disease status. Compared to LC, OC results in worse outcomes for patients with AD, with or without HIV/AIDS. Patients with HIV and AD have similar outcomes regardless of treatment option, and those with AIDS and AD have higher rates of infectious and thrombotic complications after open surgical intervention compared to patients who are managed non-operatively.