Publication:

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

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.