HIV- infection and hysterectomy hospitalizations, United States 1994-2004

Background: Although hysterectomy is one of the most common surgical procedures in women, few studies have examined hysterectomy in HIV-infected women. The objective of the current study was to compare hospitalization characteristics and indications for hysterectomy in HIV-infected women and HIV-uninfected women. Methods: We utilized data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP), 1994-2004. International Classification of Diseases 9th revision Clinical Modification (ICD-9-CM) codes were used to identify HIV infection, hysterectomy, indications for hysterectomy, comorbities, and complications. Standard methods for analyzing weighted survey data were employed using SAS- callable SUDAAN. Results: This analysis included 7,823 HIV-infected women and 6,454,963 HIV-uninfected women who underwent a hysterectomy. On average, HIV-infected women underwent hysterectomy at a younger age than non-infected women (39.7 years vs. 47.0 years, p<.001) and had a longer length of hospital stay (4.6 days vs. 3.1 days, p<.001). A greater percentage of HIV-infected women than uninfected women had a surgical or post-operative complication during hysterectomy hospitalization (34.8% vs. 25.8%, p<.001). Adjusting for age and year, HIV-infected women were more likely to have an indication of cervical cancer (OR=2.6, 95% CI 1.9-3.6), cervical intraepithelial neoplasia III (OR=8.0, 95% CI 6.9-9.2), cervical intraepithelial neoplasia I-II (OR=5.3, 95% CI 4.6-6.2), and pelvic inflammatory disease (OR=1.4, 95% CI 1.2-1.5). Discussion: HIV-infected women undergoing hysterectomy were younger, and more likely to have different indications and complications than HIV-uninfected women. Further research is need to identify the reason for these differences.