Outcome of Emergency Surgery in HIV Infected Patients in Jos

Abstract

Surgery in the immune compromised such as the HIV infected patients is a subject shrouded with some doubt and controversy because of the complications that are thought to arise following the surgery. The surgeries performed during the study period were not minimally invasive or highly specialized and was performed by general practitioners, general surgeons and gynecologist. We evaluated the outcomes of emergency surgeries among our patients using the CD4 cell count and the Hemoglobin concentration as predictors of outcome in HIV patients undergoing surgery in our clinic. This was a combined retrospective and prospective evaluation of HIV positive patients who underwent surgery at a Nongovernmental medical facility that renders free care to H IV positive patients in Jos Plateau State from January 2011- December 2013.All consenting patient and those with available medical records were recruited into the study. Non consenting patients, those with missing records and those lost to follow up were excluded from this study. Data was extracted on the type of surgery, duration of hospital stay, and complications was analyzed then matched with the hematological and immunological parameters of the patients. Obtained data was obtained using epi info version 7. Analysis was for means and standard. A total of 282 major surgeries were performed. 102(36.17%) of the patients had Obstetrics and Gynaecological surgeries, 68(24.11%0 had appendectomies, 26(9.22%) had exploratory Laparotomies, 23(8.16%0 Urologic, Orthopedic surgeries accounted for 13(4.61%); wile Pediatric surgeries accounted for 11(3.90%), other minor procedures accounted for 39(13.83%). The study population had a mean CD4 count 168.8+- 140.5cell/ml and a mean Hemoglobin concentration of 12.3+- 4.9grms. One hundred and ten patients (39%) healed normally and were discharged without complications, wile 114(40.3%) ad delayed wound healing and were discharged home after two weeks. There was 20.7% mortality in this study (58 patients).Patients that ad delayed wound healing had a mean CD4 count of 160, while mortality was seen in patients with a mean CD4 count of 150. Emergency surgery in IV infected patients with a low CD4 cell count is associated with a high morbidity and mortality