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Preoperative counts of CD4 T-lymphocytes and early postoperative infective complications in HIV-positive patients
D Savioz1, M Chilcott, C Ludwig
1Department of Digestive Surgery, University Hospital, Geneva, Switzerland.
Objective:
To assess the relationship between postoperative infective complications and the CD4 count.
Design:
Retrospective and biometric study.
Setting:
Two university hospitals, Switzerland.
Subject:
40 HIV-positive patients who had had CD4 counts done during the three months before operation.
Interventions:
Clean and contaminated gastrointestinal and orthopaedic procedures.
Main Outcome Measure:
Postoperative infective complications.
Results:
15 patients developed postoperative infective complications (38%), 6 of which (40%) were HIV-related. CD4 cell count, as well as the type of operation (contaminated or clean), influenced the infective complication rate. The risk of infective complications after a contaminated procedure when the CD4 count was below 200 mm3 was more than 50%. In clean operations, even when the CD4 cell count was close to 0, the rate of infective complications was never as high as 50%. Patients with a CD4 cell count of 500 or more have a similar rate of infective complications as HIV seronegative patients.
Conclusion:
Indications for operation in HIV-positive patients must take into account the CD4 cell count and the type of operation.