Assessing 10-Year Risk of Revision Surgery and Postoperative Complications Following Thoracic or Lumbar Fusion Surgery in HIV-Positive Patients

Study Design. Retrospective cohort study. Objective. To evaluate the 10-year risk of revision surgery and postoperative complications in HIV-positive patients undergoing thoracic or lumbar fusion, compared to matched HIV-negative controls. Summary of Background Data. As HIV-positive patients live longer due to advancements in antiretroviral therapy, the prevalence of spinal degenerative and deformity-related conditions has risen. While prior studies suggest higher complication rates in HIV-positive individuals undergoing spine surgery, long-term outcomes following thoracic or lumbar fusion remain poorly characterized. Methods. A retrospective cohort analysis was performed using a national claims database of over 170 million patients (2010–2023). Patients who underwent thoracic or lumbar fusion were categorized into deformity fusion (≥4 levels) or degenerative fusion (<4 levels). HIV-positive patients were matched 2:1 with HIV-negative controls by age, gender, and Charlson Comorbidity Index. Complications were assessed at 30 and 90 days postoperatively. Long-term outcomes, including revision surgery and complication-related procedures, were evaluated over 10 years using Cox proportional hazards models. Results. A total of 3,538 HIV-positive patients and 903,713 controls were identified, with 3,534 HIV-positive patients matched to 7,064 controls. HIV-positive patients had lower rates of acute kidney injury, urinary tract infections, myocardial infarction, and infection at 30 and 90 days. However, they showed slightly increased rates of deep vein thrombosis, dysesthesia, and motor deficits. Over 10 years, no significant differences were observed in all-cause revision surgery (HR=0.96, 95% CI: 0.75–1.22, P =0.731), decompressive laminectomy, or instrumentation removal between cohorts. Conclusion. HIV-positive status, when well-managed, does not significantly increase the risk of short- or long-term complications or revision procedures after thoracic or lumbar fusion. These findings support the surgical viability of spinal fusion in HIV-positive patients and advocate against exclusion from operative care based solely on HIV status.