DOI: http://dx.doi.org/10.18203/2349-2902.isj20210991

Study of morbidity and mortality in HIV positive surgical patients in Western Rajasthan

Mangi Lal, Narender Singh, Shaitan S. Rathore, Girija H. R.

Abstract


Background: HIV infection affects the differential diagnosis of surgical disease nutritional status and life expectancy. Some have suggested that HIV infection may also influence post-operative wound healing and complication rates. Others have stated that HIV infection should have only minor influence on decision-making for many surgical conditions and therefore standard surgical approaches are appropriate.  

Methods: All HIV positive patients admitted in general surgical wards were divided into two groups- 1. Conservative, 2. Operative. Operative patients were placed into 4 subgroups according to CDC surgical wound classification-Clean, clean-contaminated, contaminated and dirty-infected. Patients were followed up in post-operative ward till discharge or mortality. At the time of discharge outcome were rated as-Good, fair and poor.

Results: Patients between age 31-30 and 41-50 years were commonly and equally affected (60.6%). Farmer males were predominantly involved in all age groups except of age group >50 years. 28 (84.85%) patients were on ART therapy. Most common affected body part is abdomen (60.60%). In 22 (66.67%) cases operative procedure done; among them 14 (63.63%) were emergency and 8 (36.37%) were elective. Fistulectomy (25%) was commonest in elective surgeries and open appendicectomy (35.71%) was commonest in emergency surgeries. In 4 cases systemic complications occurred and one case had local complication. 30 patients were discharged in satisfactory condition and 3 patients expired.

Conclusions: No significant correlation between survival outcomes (mortality and morbidity) with hospital stay (p=0.444), between type of operation (emergency or elective) and mortality (p=0.502) and demographic and clinical variables (age, gender, hospital stay, effective antiretroviral therapy (ART) duration) to survival outcome of HIV patients.


Keywords


HIV, ART, Surgical outcome

Full Text:

PDF

References


Greene WB, De Gnore LT, White GC. Orthopedic procedures and prognosis in hemophilic patients who are seropositive for human immunodeficiency virus. J Bone Joint Surg. 1990;72:2-11.

Lowery RC, Greaves W. Acquired immune deficiency syndrome: to operate or not to operate? J Natl Med Assoc. 1987;79:807-8.

Schneider PA, Abrams DI, Rayner AA, Hohn DC. Immunodeficiency-associated thrombocytopenic purpura (IDTP). Arch Surg. 1987;122:1175-78.

Wakeman R, Johnson CD, Wastell C. Surgical procedures in patients at risk of human immunodeficiency virus infection. JR Soc Med. 1990;83:315-8.

Deziel DJ, Hyser MJ, Doolas A, Bines SD, Blaauw BB, Kessler HA. Major abdominal operations in acquired immunodeficiency syndrome. Am Surg. 1990;56:445-50.

Ayers J, Howton MJ, Layon AJ. Postoperative complications in patients with human immunodeficiency virus disease: clinical data and a literature review. Chest. 1993;103:1800-7.

Burke EC, Orloff SL, Freise CE, Macho JR, Schecter WP. Wound healing after anorectal surgery in human immunodeficiency virus-infected patients. Arch Surg. 1991;126:1267-71.

Ferguson CM. Surgical complications of human immunodeficiency virus infection. Am Surg. 1988;54:4-9.

National AIDS Control Organization and ICMR-National Institute of Medical Statistics. HIV Estimations 2017: Technical Report. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. 2018.

Sharma A, Chauhan N. Seroprevalence of HIV among General Population Attending at a Tertiary Care Hospital in Udaipur, Rajasthan, India. Int J Curr Microbiol App Sci. 2018;7(06):1774-9.

Kumawat S, Kochar A, Sironi P, Garhwal J. Socio-demographic and clinical profile of HIV/AIDS patients in HAART era at a tertiary care hospital in North-West Rajasthan, India. Int J Community Med Public Health. 2016;3(8):2088-209.

NACO. Annual Report. 2017-2018.

Sathyabama K, Kopperundevi V, Sundaram VM. Study of Surgical Problems In Hiv/Aids Patients. J Dental Med Sci. 2017;16(3):29-36.

Patel HD, Dharamdev, Patel HM, Dattaroy DD, Kacherivala S. A study on surgical conditions among HIV-AIDS case at Vadodara teaching hospital. Int J Res Med. 2014;3(4);104-7.

Antunes M, Pizzol D, Chhaganlal K, Putoto G. Surgical diseases and HIV status in patients at Central Hospital Of Beira, Mozambique. Euromediterranean Biomed J. 2018;13(19):085–9.

Hajiabdolbaghi M, Jafari S, Mansouri S, Yaghoobi MH. Hospitalizations and its related factors in HIV/AIDS patients in Tehran, Iran. Med J Islam Repub Iran. 2014;28:70.

Green S, Kong VY, Laing GL, Bruce JL, Odendaal J, Sartorius B, et al. The effect of stage of HIV disease as determined by CD4 count on clinical outcomes of surgical sepsis in South Africa. Ann R Coll Surg Engl. 2017;99:459-63.

Chauhan S, Chauhan B, Sharma H. A comparative study of postoperative complications in emergency versus elective laparotomy at a tertiary care centre Int Surg J. 2017;4(8):2730-5.

Dua RS, Wajed SA, Winslet MC. Impact of HIV AIDS on surgical practice. Ann R Coll Surg Engl. 2007;89:354-8.