Impact of bariatric surgery in patients with HIV infection: A nationwide inpatient sample analysis, 2004-2014

Objective: Despite rising rates of obesity among patients with HIV, the potential role for weight loss surgery in this population remains less clear. The primary aim of this study was to evaluate the role of bariatric surgery on relevant clinical outcomes among hospitalized obese patients with HIV. Design: Retrospective analysis using the United States Nationwide Inpatient Sample database from 2004 to 2014. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared with those without bariatric surgery. Patients: Patients with discharge co-diagnoses of morbid obesity and HIV. Intervention: Bariatric surgery. Main outcome measures: Primary outcome was in-hospital mortality. Secondary outcomes included renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, gastrointestinal strictures, micronutrient deficiency, length of stay, and hospitalization costs. Results: Among 7803 patients with discharge diagnoses of HIV and morbid obesity, 346 patients (4.4%) had bariatric surgery. The proportion of bariatric surgery in obese patients with HIV initially declined by -0.10% per year from 2004 to 2009 (P_trend<0.05), then increased at an annual rate of +0.33% from 2012 to 2014 (P_trend<0.05). On multivariable analysis, bariatric surgery did not influence mortality (P=0.98). Bariatric surgery was associated with decreased risk for renal failure, respiratory failure, and sepsis (all P<0.001). However, bariatric surgery increased the risk for postoperative strictures (IRR 2.5; 95% CI 1.5-4.5; P=0.001). Conclusion: Though initially underutilized, bariatric surgery in morbidly obese HIV patients is increasing and appears to be well tolerated and effective in significantly reducing life-threatening morbidity.