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Risk
of Postoperative Infections With Gynecologic Surgery
Rates
of Postoperative Complications among Human Immunodeficiency Virus-Infected
Women Who Have Undergone Obstetric and Gynecologic Surgical Procedures
[Grubert TA et al. CID 2002;34:822]: The authors present a retrospective
case-control study of postoperative complications after 235 obstetric
and gynecologic surgical procedures in HIV-infected women. Controls
were HIV-negative and matched by age and procedure. HIV-infected
women were more likely to suffer post-operative complications than
uninfected women. The major difference was in frequency of post-operative
fever for over 48 hours requiring antibiotic treatment. The risk
was associated with immune status as indicated by the CD4 cell count
and was unrelated to surgical prophylaxis. The results are shown
in the following table:
| Complications
of Gynecologic Surgery |
|
|
Complications
|
|
HIV
positive
n = 235
|
HIV
negative
n = 235
|
Fever
> 48 hr requiring abx
Transient fever
|
29
(12%)
35 (15%)
|
4
(2%)*
9 (4%)*
|
* p < 0.0001
Comment: This
is a provocative and controversial report due to the magnitude of
the differences and the commonly stated impression that HIV-infection
per se does not notably magnify the probability of postoperative
infections at any anatomical site. The authors also call attention
to the possible relevance of their work to the current recommendation
for Caesarean section to prevent transmission of HIV.
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