Shanthamurthy Divyashree, Manesh Abi, Zacchaeus Naveena Gp, Roy Lisa R, Rupali Priscilla
Department of Infectious Diseases, Christian Medical College, Vellore, India.
Int J STD AIDS. 2018 Sep;29(10):968-973. doi: 10.1177/0956462418764485. Epub 2018 Apr 18.
It is estimated that a quarter of patients with HIV/AIDS undergo at least one surgical procedure in their life time. Surgical outcomes in these patients from developing countries are poorly characterized and surgeons are often concerned about poor surgical outcomes, especially when their CD4 cell counts are less than 200 cells/µl. This study evaluated the surgical outcomes of HIV-infected patients undergoing various surgical procedures over a six-year period in a large tertiary care hospital from South India. Two hundred and ninety-three patients underwent 374 surgical procedures during the study period. The median duration of HIV prior to surgery was 1.9 years (range 0-18.8 years). Two-thirds (58%) were on highly active antiretroviral therapy (HAART) at the time of surgery with the median duration of this treatment being 38 months (n = 194). About one-third (35%) of surgical procedures were performed as an emergency. Abdomino-pelvic surgeries were the most common (225, 60%). Adverse surgical outcome defined as death or post-operative infection was seen in 25 (6.6%). The post-operative infection rate was 5% (20/374). The most common of these was surgical site infection observed in nine (60%) followed by pneumonia in five patients (33%) and urinary tract infection in one patient. Day 30 mortality was 2% (n = 8) and a quarter of these were reported to be related to post-operative infectious complications. On multivariate analysis, only preoperative haemoglobin of less than 10 g/dl was significantly associated with a poor surgical outcome. HIV-related parameters such as CD4 cell counts, duration of HIV infection and HAART regimen did not seem to contribute towards an adverse surgical outcome.
据估计，四分之一的艾滋病毒/艾滋病患者在其一生中至少接受过一次外科手术。发展中国家这些患者的手术结果特征描述不足，外科医生常常担心手术效果不佳，尤其是当他们的CD4细胞计数低于200个/微升时。本研究评估了印度南部一家大型三级护理医院在六年期间接受各种外科手术的艾滋病毒感染患者的手术结果。在研究期间，293名患者接受了374例外科手术。手术前艾滋病毒感染的中位持续时间为1.9年（范围0 - 18.8年）。三分之二（58%）的患者在手术时正在接受高效抗逆转录病毒疗法（HAART），这种治疗的中位持续时间为38个月（n = 194）。约三分之一（35%）的外科手术是作为急诊进行的。腹盆腔手术最为常见（225例，60%）。不良手术结果定义为死亡或术后感染的情况有25例（6.6%）。术后感染率为5%（20/374）。其中最常见的是手术部位感染，有9例（60%），其次是5例（33%）肺炎和1例尿路感染。30天死亡率为2%（n = 8），其中四分之一据报告与术后感染并发症有关。多因素分析显示，只有术前血红蛋白低于10 g/dl与不良手术结果显著相关。与艾滋病毒相关的参数，如CD4细胞计数、艾滋病毒感染持续时间和HAART治疗方案，似乎对不良手术结果没有影响。
