Emergency Abdominal Operations in the Patient with Acquired Immunodeficiency Syndrome

Burack, Joshua H.; Mandel, M.; Bizer, Lawrence S.

doi:10.1097/00132586-198910000-00033

Cited by 3 publications

(7 citation statements)

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“…The overall morbidity (49%) and mortality (37%) rates for HIV-infected individuals in the present series is comparable to most reports. [1][2][3]9,10 In fact, our rates mirror the published experience of 13 series of laparotomies in patients infected with HIV, which show a complication rate of 46% and a death rate of 30%. 4 Mortality in our study was related to an ongoing septic process, AIDS-related pathologic conditions at laparotomy, and blood product transfusions.…”

Section: Commentsupporting

confidence: 77%

“…Early reports of abdominal surgery in patients with AIDS described perioperative mortality of 50%. [1][2][3] A more recent report indicates a perioperative mortality of 12% in a series of patients with AIDS undergoing emergent laparotomy. 4 In that study, worse prognoses were found with a lack of ongoing prophylactic treatment for AIDS-related disease, active opportunistic infections, Walter Reed VI classification, 5 and ongoing sepsis at the time of operation.…”

Section: Discussionmentioning

confidence: 99%

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CD4 Cell Counts as a Prognostic Factor of Major Abdominal Surgery in Patients Infected With the Human Immunodeficiency Virus

Albaran

Webber²,

Steffes

1998

Arch Surg

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To measure the prognostic utility of helper T-cell (CD4) counts in human immunodeficiency virus (HIV)-infected patients undergoing major abdominal surgery. Design: Retrospective case series. Setting: Three university-affiliated hospitals. Patients: Forty-three HIV-infected patients undergoing major abdominal surgery. Main Outcome Measures: Morbidity and mortality rates with respect to CD4 cell counts. Results: Nineteen of 32 patients who had CD4 cell counts less than 0.20ϫ10 9 /L (200 cells/µL) suffered major complications compared with 2 of 11 patients who had CD4 cell counts greater than 0.20ϫ10 9 /L (200 cells/µL) (P=.03). Perioperative mortality was 38% for patients with CD4 cell counts less than 0.20ϫ10 9 /L, and was 9% for those with CD4 cell counts greater than 0.20ϫ10 9 /L (P=.13). Six months postoperatively, mortality rates were 47% and 9%, respectively (P=.03). Of patients with septic processes perioperatively (n=12), mortality was 75%,

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Section: Commentsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

CD4 Cell Counts as a Prognostic Factor of Major Abdominal Surgery in Patients Infected With the Human Immunodeficiency Virus

Albaran

Webber²,

Steffes

1998

Arch Surg

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“…11,12 High mortality and morbidity rates had been reported in various studies on abdominal surgery in HIV-infected patients. 6 Our mortality rate of 7% (6 out of 85) is much lower than reported rates of 19% to 48% in AIDS patients. Acceptable morbidity and mortality rates are achievable in this immunocompromised group as we see in normal patients.…”

Section: Discussioncontrasting

confidence: 51%

“…Since the initial descriptions of HIV and AIDS-defining illnesses, many reports have validated the safety of abdominal surgery in the HIV/AIDS patient. (1)(2)(3)(4)(5)(6)(7)(8) Immune status has been implicated as a marker of potential outcome in patients with HIV/AIDS. The introduction ofhighly active antiretroviral therapy (HAART) in the mid-1990s heralded a new era in the treatment of HIV/AIDS.The impact of HAART on surgical outcomes has beenshown to be protective in some series (9) but without overall improvement in others.…”

Section: Introductionmentioning

confidence: 99%

Study on Acute Abdomen In HIV Infected Patients

Ramya¹,

Nareshkumar²

2017

IOSR JDMS

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“…4,18 Figure 2 shows the most frequently performed emergency operations in AIDS patients. 9, 16,17,[19][20][21][22] Emergency operations usually are required for AIDS-related complications, but non-AIDS-related conditions (eg, acute appendicitis) may develop and be masqueraded by underlying AIDS symptomatology.…”

Section: Indications For Operationmentioning

confidence: 99%

AIDS, Emergency Operations, and Infection Control

Wittmann

1996

Infect. Control Hosp. Epidemiol.

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Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) may turn out to be the largest lethal epidemic of infection ever. The estimated global number of HIV-infected adults in 1993 was 13 million, with projections of up to 40 million by the year 2000. Human immunodeficiency virus infections and AIDS are relevant to surgeons with respect to the surgical management of AIDS patients in general, the treatment of the increasingly long list of surgical complications specific to AIDS patients in particular, and the risks of patient-to-surgeon and surgeon-to-patient HIV transmission. Because of migration of individuals and populations throughout the world, even surgeons practicing in relatively unaffected regions should be familiar with the potential surgical implications of AIDS. Ethical considerations arise, as well. Are surgeons obliged to operate on HIV-positive or AIDS patients? Some surgeons adhere strictly to the Hippocratic Oath, whereas others reserve the right to be selective on whom they operate, except in emergencies. Other common ethical considerations in the AIDS patient are similar to those arising in the terminal cancer case: whether to operate or not; whether to provide advanced support such as total parenteral nutrition or hemodialysis. Answers are not simple and require close collaboration between the surgeon, the AIDS specialist, and involved members of other specialties. Emergency operations become necessary to treat AIDS independent disease such as acute cholecystitis and appendicitis or AIDS-related life-threatening conditions such as gastrointestinal bleeding, obstruction, perforation, or ischemia complicating Kaposi's sarcoma, lymphoma, and cytomegalovirus or disseminated nontuberculous mycobacterial infections. Delays and errors in diagnosis are frequent. Poor nutritional state with weight loss, low serum albumin, and leukocyte count prevails in most patients requiring emergency operations and account for a high mortality. By applying solid judgment and selecting management appropriately, the surgeon has the ability to prolong life and to improve the quality of life for these unfortunate patients, and to do so with extremely minimal risk to himself and his team.

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Emergency Abdominal Operations in the Patient with Acquired Immunodeficiency Syndrome

Abstract: \s=b\We have reviewed the medical records of ten patients with acquired immunodeficiency syndrome who required emergency celiotomy in a three-year period. These

Cited by 3 publications

References 0 publications

CD4 Cell Counts as a Prognostic Factor of Major Abdominal Surgery in Patients Infected With the Human Immunodeficiency Virus

CD4 Cell Counts as a Prognostic Factor of Major Abdominal Surgery in Patients Infected With the Human Immunodeficiency Virus

Study on Acute Abdomen In HIV Infected Patients

AIDS, Emergency Operations, and Infection Control

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