Penetrating trauma and emergency surgery in patients with AIDS

: Several recent publications have suggested that emergency surgery in patients with acquired immunodeficiency syndrome (AIDS) is associated with extremely high morbidity and mortality. : We reviewed the records of 21 patients with AIDS at the University of Miami/Jackson Memorial Medical Center in Miami, Florida, who underwent 24 emergency operations after sustaining penetrating trauma. : Nineteen patients (90%) presented with gunshot wounds and 2 (10%) presented with stab wounds. Two patients underwent multiple surgical procedures to control hemorrhage from a complex liver injury and to drain a retained hemothorax, respectively. After surgery, patients were managed according to standard protocols, the same as those for non-AIDS patients. Wound infection was present in 4 patients (19%), and occurred only in patients with <100 CD4+ cells/μL. Fifty-seven percent of patients had no prior knowledge of having AIDS or being seropositive for the human immunodeficiency virus. One patient died after surgery and 18 patients (86%) were still alive 6 months after discharge. : As the AIDS epidemic grows, general surgeons will be treating an increasing number of these patients. A low morbidity and mortality can be obtained with standard surgical care and techniques. Complications are not uncommon and should be treated as in any other surgical patient, unless it is a terminal condition or that posture runs against the patientʹs stated views or advance directives.