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Renato G. Albaran, MD; John Webber, MD; Christopher P. Steffes, MD

Arch Surg. 1998;133:626-631.

Objective  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 0.20x10⁹/L (200 cells/µL) suffered major complications compared with 2 of 11 patients who had CD4 cell counts greater than 0.20x10⁹/L (200 cells/µL) (P=.03). Perioperative mortality was 38% for patients with CD4 cell counts less than 0.20x10⁹/L, and was 9% for those with CD4 cell counts greater than 0.20x10⁹/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%, and was 19% (P=.009) for those with nonseptic processes (n=31). Nine patients had HIV-related intra-abdominal pathologic conditions at laparotomy. Mortality was 56% perioperatively (P=.13) and 88% after 6 months (P=.001). Sixty-eight percent of patients who received blood product transfusions developed complications, whereas only 7% of those who did not receive transfusions developed complications (P<.001). Overall mortality and morbidity rates were 37% and 49%, respectively. Patients with morbidity had lower CD4 cell counts (median, 0.034x10⁹/L) than those without complications (median,0.102x10⁹/L) (P=.02). Similarly, patients who died had lower CD4 cell counts (median, 0.031x10⁹/L vs 0.088x10⁹/L) (P=.05).

Conclusions  Patients with acquired immunodeficiency syndrome–defining CD4 cell counts undergoing major abdominal surgery developed more complications and had poorer outcomes at 6-month follow-up compared with HIV-infected patients whose CD4 cell counts were greater than 0.20x10⁹/L (200 cells/µL). A perioperative septic process and HIV-related pathologic conditions seen at laparotomy are also associated with worse outcomes.

From the Department of Surgery, Wayne State University School of Medicine, Detroit, Mich.

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