Chest
Volume 103, Issue 6, June 1993, Pages 1800-1807
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Clinical Investigations
Postoperative Complications in Patients With Human Immunodeficiency Virus Disease: Clinical Data and a Literature Review

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Objective: To compare complications after and outcome from surgical procedures between patients with human immunodeficiency virus (HIV) disease and a matched control population.

Design: Retrospective case review.

Setting: 476-bed university tertiary care center.

Patients: Of 343 patients diagnosed as having HIV disease between 1981 and September 1991, 26 (7.6 percent) were Walter Reed classifications system 3B or greater and underwent a surgical procedure with general anesthesia or, in the case of 2 patients, regional anesthesia, at the study hospital. These patients were matched to 26 control patients by severity of illness according to APACHE II severity of illness score and by age, sex, race, and anesthetic regimen. Measurements and Results: The postoperative occurrence of dysrhythmia, hypotension, hypoxia, hemorrhage, renal insufficiency, or infection was evaluated in the study and control groups. Deaths within 3 and 30 days of the procedure and duration of survival after discharge from the hospital were recorded. Frequency of complications and 3- and 30-day mortality did not differ between the 2 groups. Duration of survival after discharge from the hospital in patients with HIV disease (7.4 ± 9.7 months) was approximately 25 percent that in control patients (30.6 ± 35.9 months) (p = 0.02).

Conclusions: HIV disease does not increase the risk of postprocedural complications, including death, up to 30 days postprocedure. Thereafter, patients with HIV disease classified by the Walter Reed System as ≥ 3B may survive for a shorter time than do equally ill patients who do not have HIV disease. Thus, needed surgical intervention should not be limited based on HIV status and concern for subsequent complications.

(Chest 1993; 103:1800-07)

Section snippets

Study Population

The records of all patients with HIV disease or AIDS who had been cared for at our hospital, a 476-bed tertiary care university medical center, from 1981 through September 1991 were reviewed. Patients' records were identified by a computer search for the 1CD-9 diagnostic code (International Classification of Diseases, 9th edition) for the terms AIDS, immune deficiency, acquired immune deficiency, Pneumocystis carinii pneumonia, AIDS-related complex, and HIV disease. HIV disease was diagnosed by

RESULTS

Between 1981 and September 1991, HIV disease was diagnosed in 343 patients (Table 1). Data from 55 who were ≤13 years of age and 12 who were pregnant and admitted for vaginal delivery without general anesthesia were excluded from the study. Of the remaining 276, 24 were categorized under the Walter Reed system as class 3B or greater and underwent a surgical procedure with general anesthesia; 2 patients underwent a major surgical procedure with regional anesthesia. These 26, who comprised 14

DISCUSSION

Because the only basis for medical judgments about treatment should be whether it is effective and benefits the patient,25 we performed this study to determine whether morbidity and mortality differ between patients with advanced HIV disease and those without HIV disease but an illness of similar severity, when both groups undergo a surgical procedure. If HIV disease were associated with an increased risk from surgical procedures, this could indicate that different surgical guidelines for these

ACKNOWLEDGMENTS

This work was supported in part by a grant from the Foundation for Anesthesia Education and Research. Lynn Dirk provided editorial assistance. Joseph W. Shands, Jr., M.D., provided critical and thoughtful commentary.

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This research was supported in part by the Foundation for Anesthesia Education and Research. Ms. Ayers was partly funded by a fellowship from the Medical Student Research Program of the National Institutes of Health, grant 5-T35-HL07489.

Presented in part at the 82nd Annual Scientific Assembly, Southern Medical Association, New Orleans, November 6-9, 1988.

Manuscript received June 29; revision accepted October 15

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