Outcome of Surgery in HIV-positive and negative patients; a general comparative study

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Mugala, Duncan Dan
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There have been anecdotal reports that patients who a;'e infected with the human Immune Deficiency Virus (HIV) do not fare well when they undergo surgery (Gkong 1988). Clinical experience in the University Teaching Hospital Lusaka seems to support this (Watters 1988), especially in orthopaedics where a rather high rate of late post operative i«nfection nas been noted; particulary in those patients with surgical implants (Jellis 1988). •Studies documenting the morbidity after surgery on asymptomatic HIV-positive people-are, however, nard to come by {Greene 1990 ).In Africa, changes in the presentation and behaviour of common diseases are being seen. Complication patterns are also changing due to infection with HIV. Entirely nev^ syndromes are appearing. Several important changes are being recognised. (Bayley 1 990) Some of these are;a. Increased incidence of sepsis arising spontaneously or as a complication of elective surgery: A study done by D.A.K. Watters in 1987 and 1988 showed; that out of 65 patients admitted to the I.C.U., 29 (44%) were HIV-positive in contrast to 13% of the 70 patients admitted to the unit during the same period for obstetric problems (Watters 198S). The difference was statistically significant. The outcome of surgery was worse in the HIV-positive group, of whom 65% died compared to the HIV-negative group with a mortality of 42%. The difference was not however statistically significant.b.Impaired wound healing. This is largely an anecdotal observation, and nt)t all surgeons agree that HIV disease impairs wound nealing (Bay ley 1990; Wakeman 1990). It has been noted however that HIV patients have a higher tendency to wound dehiscence and may develop pressure sores usually after a short period of confinement to bed (Bay ley 1990).In the United Kingdom, the most frequent reason for surgical referral of HIV-positive patients is anorectal disease (Miles 1990). In our setting the whole spectrum of surgery appears to be affected by HIV infection (Bayley 1990).
Surgery , HIV- - Zambia