Disparities in Emergent Surgical Care in People Living with HIV

Abstract

Introduction:

People living with HIV (PLWHIV) have historically faced discrimination and unequal access to healthcare in the United States. This study aims to investigate differences in surgical intervention for common surgical emergencies among this population, specifically cholecystitis and appendicitis.

Methods:

This study utilized the TriNetX® database to compare the rate of cholecystectomies and appendectomies among PLWHIV with diagnosed cholecystitis or appendicitis, respectively, compared with HIV-negative patients. Inclusion criteria were an indication for surgical intervention, cholecystitis (K81) or appendicitis (K35–37). Cohorts were defined by HIV status, and analysis was stratified by procedure. Cohorts were propensity matched for age, race, leukocyte count, HIV 1 RNA volume, and substance abuse disorders. Outcomes were defined as patients receiving cholecystectomy or appendectomy in two separate analyses. Relative difference (RD) and relative risk (RR) were compared with between HIV+ and HIV− cohorts.

Results:

The cholecystectomy analysis had 609,127 total patients, with 3,597 per cohort after matching. The appendectomy analysis had 641,395 total patients, with 2,368 per cohort after matching. HIV-positive patients with cholecystitis had a 16.736% risk of undergoing cholecystectomy compared with 23.019% risk in HIV-cholecystitis patients (RD: −6.283% [95% confidence interval (95% CI): −8.122%, −4.444%], p < 0.0001, RR 0.727 [95% CI: 0.662, 0.799]). HIV-positive patients with appendicitis had a 14.147% risk of undergoing appendectomy compared with 17.272% in HIV-appendicitis patients (RD: −3.125%% [95% CI: −5.196%, −1.054%], p < 0.0031, RR 0.819, [95% CI 0.717, 0.935]).

Conclusions:

This study demonstrates a significant disparity in timely surgical intervention for PLWHIV. Further investigation is needed to elucidate the etiology of demonstrated incongruencies and their clinical relevance.