Rogers A S, Froggatt J W, Townsend T, Gordon T, Brown A J, Holmes E C, Zhang L Q, Moses H
AIDS Administration, Maryland State Department of Health and Mental Hygiene, Baltimore.
JAMA. 1993 Apr 14;269(14):1795-801.
To ascertain if a surgeon infected with the human immunodeficiency virus (HIV) transmitted HIV to patients during invasive surgical procedures.
Survey of patients and acquired immunodeficiency syndrome (AIDS) case registries, and laboratory analysis of nucleotide sequence data.
One surgeon's private and institutional practices within one academic referral hospital.
A total of 1131 persons identified in hospital databases who underwent invasive surgical procedures from 1984 through 1990 and for whom the surgeon was listed as the admitting or operating surgeon.
Patients presumed to be living were surveyed by mailed questionnaire. The AIDS case registries were reviewed for all patients having undergone invasive procedures and death certificates were obtained. Person-hours of surgery during which exposure might have occurred were calculated for surgical procedures.
Of 1131 patients, 101 were dead, 119 had no address, 413 had test results known, and 498 did not respond to the questionnaire. No study patient name was found in reported AIDS case registries. One newly detected, HIV-seropositive patient was determined (through nucleotide sequencing) to have been most probably infected in 1985 during a transfusion. There was no HIV transmission in 369 person-hours of surgical exposure, indicating that HIV transmission to patients is unlikely to occur more frequently than once per 1000 person-hours of surgical exposure.
If study validity and resources permit, investigation of publicly disclosed, HIV-infected health care workers whose practices involve invasive procedures should be pursued. The risk of HIV transmission during surgery may be so small that it will be quantified only by pooling data from multiple, methodologically similar investigations.
确定感染人类免疫缺陷病毒（HIV）的外科医生在侵入性手术过程中是否会将HIV传播给患者。
对患者及获得性免疫缺陷综合征（AIDS）病例登记处进行调查，并对核苷酸序列数据进行实验室分析。
一家学术转诊医院内一名外科医生的私人诊所和机构执业场所。
医院数据库中识别出的1131人，他们在1984年至1990年期间接受了侵入性手术，且该外科医生被列为入院或主刀医生。
通过邮寄问卷对推测还活着的患者进行调查。查阅所有接受侵入性手术患者的AIDS病例登记处，并获取死亡证明。计算手术过程中可能发生暴露的手术人时数。
1131名患者中，101人死亡，119人无地址，413人有已知检测结果，498人未回复问卷。在报告的AIDS病例登记处未发现研究患者的姓名。确定一名新检测出的HIV血清阳性患者（通过核苷酸测序）很可能在1985年输血期间感染。在369手术人时的暴露中未发生HIV传播，这表明HIV传播给患者的可能性不太可能超过每1000手术人时发生一次。
如果研究的有效性和资源允许，应对公开披露的、其执业涉及侵入性手术的HIV感染医护人员进行调查。手术期间HIV传播的风险可能非常小，以至于只有通过汇总多个方法学相似的调查数据才能进行量化。
