Abstract C073: Differences in short-term complications after cancer surgery by HIV status among Medicaid beneficiaries from 2001-2021

Abstract Background: Past studies have shown that people with HIV (PWH) have higher cancer-specific mortality and may have worse outcomes after cancer surgery; however, this has been based on a very limited sample size and/or using data prior to the treat-all era of antiretroviral therapy (ART). We explored outcomes after initial cancer surgery in a large sample of Medicaid beneficiaries. Study Population: 198,535 Medicaid beneficiaries with at least one cancer surgery in 27 states and Washington D.C. from 2001-2021 including 4,199 PWH (2.1%) at the time of cancer surgery. Methods: We identified the first instance of cancer surgery for anal, bladder, breast, colorectal, female genitourinary, gastroesophageal, head and neck, kidney, liver, lung, ovary, or pancreatic cancer among Medicaid beneficiaries with at least 6 months of continuous enrollment prior to surgery to identify HIV status and at least 3 months of enrollment after surgery to identify outcomes. We compared length of stay (LOS) during the initial surgery, 30-day readmission, 90-day mortality, rates of emergency department (ED) visits, and surgical site infection within 90 days by HIV status using multivariable linear or logistic regression adjusted for age, sex, year of surgery, state of residence, Charlson Comorbidity Index count, cancer type, location of surgery (inpatient or outpatient), and receipt of radiation, infusion chemotherapy, and/or oral chemotherapy prior to surgery. Results: PWH were more likely to have inpatient surgery than those without HIV (72.6% vs. 56.4%), and PWH had lower rates of radiation (21.0% vs. 16.0%) and infusion chemotherapy (26.1% vs. 12.6%) prior to surgery than those without HIV. Compared to those without HIV, PWH had longer LOS (7.0 vs. 4.3 days) with an adjusted mean difference of 0.94 days (95% confidence interval [CI]=0.74-1.13), a higher 90-day mortality (3.2% vs. 1.8%) with an adjusted risk ratio [RR]=1.33 (95% CI=1.11-1.60), and slightly more ED visits during the 90 day follow-up (0.85 visits vs. 0.55 visits per 90 days) with an adjusted mean difference of 0.22 (95% CI=0.18-0.26). There were no statistically significant differences in 30-day readmission or surgical site infection. Findings were similar when restricting to only those receiving inpatient surgery. Among only those receiving surgery for breast cancer (the most common cancer), there were no observed differences in 90-day mortality among inpatient surgeries (RR=0.71, 95% CI=0.17, 2.93); however, those receiving outpatient surgeries had higher 90-day mortality (RR=3.52, 95% CI=1.61, 7.71). Conclusions: Overall, Medicaid beneficiaries with HIV had similar LOS, but worse 90-day mortality and increased ED visits after cancer surgery as compared to those without HIV. Differences between surgical outcomes may be more pronounced for some cancers than others and/or by surgical setting. Citation Format: Corinne Joshu, Keri Calkins, Jacqueline Rudolph, Xiaoqiang Xu, Eryka Saylor, Yiyi Zhou, Maylin Palatino, Karine Yenokyan, Bryan Lau. Differences in short-term complications after cancer surgery by HIV status among Medicaid beneficiaries from 2001-2021 [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C073.