In-Hospital Outcomes of Bariatric Surgery in People Living with HIV: A Nationwide Analysis

Abstract

Background: Bariatric surgery is a growing treatment for Class 3 obesity in people with HIV, but concerns remain about antiretroviral therapy pharmacokinetics, comorbidities, and mortality. Existing studies confirm safety but are limited by small sample sizes and outdated cohorts. This study utilizes a recent, large U.S. inpatient cohort to address gaps. Methods: We performed a retrospective cohort study using the Nationwide Inpatient Sample from 2015 to 2021, identifying hospitalizations for bariatric surgery among patients with and without HIV. We compared demographics, comorbidities, and hospitalization outcomes between groups. We analyzed in-hospital mortality using Weibull regression and identified independent predictors via multivariable Cox proportional hazards models. Results: Of 112,348 bariatric surgery hospitalizations, 1,204 (1.1%) were in HIV-positive patients. HIV-positive patients were younger (51.0 vs. 56.1 years; p < 0.001), predominantly male (72.0% vs. 40.3%; p < 0.001), and had longer median lengths of stay (14.2 vs. 10.7 days; p < 0.001). Bariatric surgery rates among HIV-positive patients remained stable from 2017 to 2021 (p = 0.4). Compared with HIV-negative patients, those with HIV had higher prevalences of liver disease (11.7% vs. 1.7%; p < 0.001), renal disease (12.7% vs. 9.2%; p < 0.001), and a history of cancer (26.3% vs. 15.7%; p < 0.001). In unadjusted Weibull regression, HIV-positive status was associated with better in-hospital survival (p = 0.001), but after adjustment, HIV was not an independent predictor of mortality (HR 0.97; p = 0.843). Independent predictors of mortality across the entire cohort included advancing age (HR 1.04 per year; p < 0.001), sepsis (HR 3.36; p < 0.001), and liver disease (HR 1.70; p < 0.001). Conclusion: Bariatric surgery is safe for HIV-positive patients. Despite stable utilization, disparities persist. Further research is needed to improve access and assess long-term outcomes.