HIV and Hepatitis C Virus-Related Disparities in Undergoing Emergency General Surgical Procedures in the United States, 2016-2019

Objective: To determine whether people living with HIV (PLWHIV) and people living with HCV (PLWHCV) experience inequities in receipt of emergency general surgery (EGS) care. Summary Background Data: PLWHIV and PLWHCV face discrimination in many domains; it is unknown whether this extends to receipt of EGS care. Methods: Using data from the 2016-2019 National Inpatient Sample, we examined 507,458 non-elective admissions of adults with indications for one of the seven highest-burden EGS procedures (partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, or laparotomy). Using logistic regression, we evaluated the association between HIV/HCV status and likelihood of undergoing one of these procedures, adjusting for demographic factors, comorbidities, and hospital characteristics. We also stratified analyses for the seven procedures separately. Results: After adjustment for covariates, PLWHIV had lower odds of undergoing an indicated EGS procedure (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.73-0.89), as did PLWHCV (aOR, 0.66; 95% CI, 0.63-0.70). PLWHIV had reduced odds of undergoing cholecystectomy (aOR, 0.68; 95% CI, 0.58-0.80). PLWHCV had lower odds of undergoing cholecystectomy (aOR, 0.57; 95% CI, 0.53-0.62) or appendectomy (aOR, 0.76; 95% CI, 0.59-0.98). Conclusions: People living with HIV and HCV are less likely than otherwise similar patients to undergo EGS procedures. Further efforts are warranted to ensure equitable access to EGS care for PLWHIV and PLWHCV.