{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T18:25:20Z","timestamp":1771525520548,"version":"3.50.1"},"posted":{"date-parts":[[2026,2,14]]},"group-title":"Epidemiology","reference-count":38,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,2,17]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>People with HIV (PWH) experience higher cancer-specific mortality and may have worse surgical outcomes than people without HIV (PWoH), though the limited prior evidence largely predates the treat-all antiretroviral therapy (ART) era. We examined postoperative outcomes among PWH and PWoH enrolled in Medicaid in 26 states and Washington, D.C. from 2001\u20132021.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We identified the first inpatient\/outpatient surgery for anal, bladder, breast, colorectal, female genitourinary, gastroesophageal, head and neck, kidney, liver, lung, ovarian, or pancreatic cancer among adults with continuous enrollment for at least 6 months pre- and 3 months post-surgery. Outcomes included length of stay (LOS), 7- and 30-day readmissions (overall and unplanned), emergency department (ED) use, surgical site infection (SSI), and mortality (30-day, 90-day, 1-year, 5-year). Linear, logistic, and Cox proportional hazards models were adjusted for demographics, comorbidities, cancer type, surgical setting and risk, metastasis, and preoperative treatment (radiation\/chemotherapy).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 198,535 beneficiaries undergoing cancer surgery, 4,199 (2.1%) were PWH. PWH were more likely to have inpatient procedures (72.6% vs. 56.4%). Compared to PWoH, PWH had more utilization with longer LOS (7.0 vs. 4.3 days; adjusted mean difference [aMD] = 0.79, 95% CI = 0.60\u20130.99), extended hospital stays (13.8 vs. 7.4 days; aMD=2.76, 95% CI= 2.42-3.10), and more ED visits (0.82 vs. 0.55 per 90 days; aMD = 0.19, 95% CI = 0.15\u20130.23). There were no significant differences in readmission, SSI, or 30-day mortality. PWH had higher 90-day mortality (3.2% vs. 1.8%; adjusted odds ratio [aOR] = 1.31, 95% CI = 1.08-1.57), though this was attenuated in the treat-all ART era (2012 \u2013 2021). Results were similar for inpatient surgeries and most common cancer types. PWH had an elevated hazard of 1-year and 5-year mortality post-surgery with an adjusted hazard ratio [aHR] of 1.31 (95% CI = 1.17-1.46) and 1.22 (95% CI= 1.14-1.31), respectively, especially for colorectal cancer (1-year aHR= 1.53, 95% CI=1.24-1.88; 5-year aHR=1.32, 95% CI= 1.14-1.52).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>PWH had higher post-cancer surgery utilization but similar short-term complications, which supports current guidelines to provide standard cancer care for PWH. More work is needed to elucidate the factors contributing to higher long-term mortality among PWH.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.02.12.26346189","type":"posted-content","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T16:50:14Z","timestamp":1771087814000},"source":"Crossref","is-referenced-by-count":0,"title":["Differences in utilization, complications, and mortality after cancer surgery by HIV status among Medicaid beneficiaries from 2001-2021"],"prefix":"10.64898","author":[{"given":"Corinne E.","family":"Joshu","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"},{"name":"Department of Oncology, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keri","family":"Calkins","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"},{"name":"Mathematica, Ann Arbor, MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline E.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiyi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maylin","family":"Palatino","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karine","family":"Yenokyan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eryka","family":"Saylor","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD"},{"name":"Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026021909401083000_2026.02.12.26346189v2.1","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jamaoncol.2025.1589","article-title":"Cancer Incidence and Trends in US Adults With HIV","volume":"11","year":"2025","journal-title":"JAMA Oncol"},{"key":"2026021909401083000_2026.02.12.26346189v2.2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000003318"},{"key":"2026021909401083000_2026.02.12.26346189v2.3","doi-asserted-by":"crossref","first-page":"866","DOI":"10.7326\/M17-2499","article-title":"Projected Cancer Incidence Rates and Burden of Incident Cancer Cases in HIV-Infected Adults in the United States Through 2030","volume":"168","year":"2018","journal-title":"Ann. 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