Surgical outcomes in HIV positive patients following major surgery at two tertiary institutions in Harare, Zimbabwe

Abstract

Background: Human Immunodeficiency Virus (HIV) traditionally has been associated with poorer outcomes among the critically ill. Recent evidence suggests that the outcomes of surgical patients have improved with increased use of antiretroviral regimens. We set out to find if this is true for major surgical procedures in Zimbabwe. Methods: A prospective cohort study was done on 215 patients who underwent major surgical procedures at the two main tertiary hospitals in Harare between June 2015 and April 2016. Dependent variables considered were surgical outcomes and length of hospital stay (LOS). Independent parameters which were studied included patient's demographics, HIV status, clinical features, diagnosis, investigations, and procedures carried out. The data was analysed using STATA statistical package version (STATA 13). Results: The mean age was 47.1years (SD = 18.1) and 43% were males. The HIV prevalence was 28%. Of the HIV positive patients, 16% had CD4 count <200 cells/mm3, 42% with CD4 counts between 200 and 400 cells/mm3 and 42% with CD4 counts >500 cells/mm. In HIV positive patients the common major operations performed were total abdominal hysterectomies (19%), amputations (16%) and perforated viscus (8%). The length of hospital stay in HIV positive patients was 14.4 days (SD = 10.8) compared to 10.9 days (SD = 6.7) in HIV negative patients. Surgical site infections and pneumonia were the most common postoperative complications seen. There was no difference in LOS in HIV positive patients on HAART (LOS = 15.2 days) and those not on HAART (LOS = 14.2 days) and the post operative complications were comparable between the two groups. Mortality was 3%. Conclusion: Surgical site infections (25%) and pneumonia (32%) are the most common short term postoperative complications in HIV positive patients. Low CD4 count was associated with higher rates of surgical site infections (64%) and pneumonia (72%) in HIV positive patients. There was high prevalence (28%) of HIV positivity in patients undergoing major operations at the two tertiary hospitals compared to HIV prevalence in the general adult population in Zimbabwe. Highlights:

Prevalence of HIV in surgical patients at the Rivers State University Teaching Hospital

“…Taking into consideration that HIV infections could be transmitted during surgical procedures makes it more worrisome to surgeons [2][3][4][5]. for this reason, preventive measures should be taken by surgeons before, during and after surgery due to the fact HIV infection is a blood borne infection [6][7][8][9][10].…”

“…We all need to redouble our effort to reach the proposed global target of 95-95-95 recommended by UNAIDS, especially with respect to the excess of one million deaths recorded in Africa [6]. In addition, with the outbreak of covid-19 pandemic [3][4][5][6]. HIV preventive services has been disrupted leading to increasing number of HIV infections [4][5][6][7][8][9][10].…”

“…Furthermore, in African countries there is variation of the prevalence ofHIV infections with a prevalence of 1.4% from Nigeria [8]. It is however worrisome because in the globe 70% of persons living with HIV are resident in Sub-Sahara Africa [3,47,8]. From the inception of the disease condition HIV has claimed 36.6 million lives so far [1,2].…”