A growing spectrum of surgical disease in patients with human immunodeficiency virus/acquired immunodeficiency syndrome. Experience with 120 major cases
N. A. Diettrich, J. C. Cacioppo, G. Kaplan and S. M. Cohen
Department of Surgery, Illinois Masonic Medical Center, Chicago.
One hundred twenty major general surgical procedures were performed on 88
adult patients harboring the human immunodeficiency virus. Fifty-eight
(48%) of the procedures were performed on patients who fulfilled the
criteria for acquired immunodeficiency syndrome. The patients were
predominantly male (94%). Single risk factors included homosexuality (73%
of cases), intravenous drug abuse (8%), and previous blood transfusions
(8%). Four patients (5%) had multiple risk factors; risk factors were
denied by seven patients (8%). The mean age at surgery was 41.6 years
(range, 22 to 67 years). Surgical conditions that rarely affect the
population without the human immunodeficiency virus presented diagnostic
challenges. Altered physiologic responses to even routine conditions were
observed. Thirty-day morbidity rates for emergency (group A) and elective
(group B) procedures were 19% and 9%, respectively. This included seven
surgical deaths (13%) in group A and one in group B (2%). Patients
undergoing 92 of 112 procedures (82%) not associated with surgical
mortality were followed up. Patients who were dead at follow-up had mean
procedure-survivals of 19 weeks (group A) and 21 weeks (group B) for 33
procedures. Those who remained alive had a mean procedure-survival of 86
weeks for 59 procedures. No single prognosticator could be correlated with
outcome, although the combination of hypoalbuminemia with a history of
opportunistic infection(s) was associated with short survival. Emergency
and elective procedures can be performed in the patient with human
immunodeficiency virus/acquired immunodeficiency syndrome with acceptable
morbidity and mortality. Procedures are indicated to extend patient life or
to improve quality of life.
