PENETRATING TRAUMA AND EMERGENCY-SURGERY IN PATIENTS WITH AIDS

BACKGROUND: Several recent publications have suggested that emergency surgery in patients with acquired immunodeficiency syndrome (AIDS) is associated with extremely high morbidity and mortality. PATIENTS AND M ETHODS: We reviewed the records of 21 patients with AIDS at the Univer sity of Miami/Jackson Memorial Medical Center in Miami, Florida, who u nderwent 24 emergency operations after sustaining penetrating trauma. RESULTS: Nineteen patients (90%) presented with gunshot wounds and 2 ( 10%) presented with stab wounds. Two patients underwent multiple surgi cal procedures to control hemorrhage from a complex liver injury and t o drain a retained hemothorax, respectively, After surgery, patients w ere managed according to standard protocols, the same as those for non -AIDS patients. Wound infection was present in 4 patients (19%), and o ccurred only in patients with <100 CD4+ cells/mu L. Fifty-seven percen t of patients had no prior knowledge of having AIDS or being seroposit ive for the human immunodeficiency virus. One patient died after surge ry and 18 patients (86%) were still alive 6 months after discharge. CO NCLUSIONS: As the AIDS epidemic grows, general surgeons will be treati ng an increasing number of these patients. A low morbidity and mortali ty can be obtained with standard surgical care and techniques. Complic ations are not uncommon and should be treated as in any other surgical patient, unless it is a terminal condition or that posture runs again st the patient's stated views or advance directives.