Abstract: Poster Presentations |

Thoracic Surgery in Patients with HIV Disease FREE TO VIEW

Marc Margolis, MD*; Barbara Tempesta, CRNP; Matthew Facktor, MD; David Salter, MD; Nevin Katz, MD; Vicky Cole, CRNP; Farid Gharagozloo, MD
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George Washington University Medical Center, Washington, DC


Chest. 2004;126(4_MeetingAbstracts):919S. doi:10.1378/chest.126.4_MeetingAbstracts.919S
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PURPOSE:  With the introduction of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) infection has become a more chronic disease with improved survival. Thoracic surgeons are increasingly involved in surgical procedures in this patient population. Surgical indications and outcomes are important variables in treating these patients.

METHODS:  A retrospective review of patients operated on at three institutions over a 3-year period (2002 - 2004) was performed.

RESULTS:  21 patients with HIV underwent surgery during this time period. A total of 22 procedures were performed. There were 13 males and 8 females. Age ranged from 15 - 64 years. Patients with known HIV infection prior to hospital admission numbered 18/21. Eleven patients had previously been diagnosed with AIDS. 11/21 patients were using HAART prior to admission. CD4 counts ranged from 1 - 1079 /ul. Indications for surgery included respiratory failure of uncertain etiology in 6/21 undergoing lung biopsies, empyemas in 4/21 undergoing decortications, mediastinal adenopathy in 2/21 undergoing VATS biopsy or mediastinoscopy, bronchopleural fistula in 2/21 undergoing lung resection, pleural tents and muscle flaps, pericardial tamponade in 2/21 undergoing VATS pericardial windows, vertebral collapse in 1/21 undergoing a thoracoabdominal approach for corpectomy and stabilization, rib lesions in 1/21 undergoing bilateral rib biopsies, undiagnosed pleural effusion in 1/21 undergoing diagnostic VATS and pleurodesis, fibrothorax with restrictive lung disease in 1/21 undergoing decortication and pleurectomy and esophageal cancer in 1/21 undergoing Ivor Lewis esophagectomy and later a tracheostomy. 4/21 patients died and the remaining were discharged home (15/17) or to a rehabilitation unit (2/17). All four patients who died had initially undergone non-diagnostic bronchoscopies followed by surgical lung biopsies. There were no needle stick injuries.

CONCLUSION:  Despite the presence of HIV disease, thoracic surgical procedures appear safe in a select group of patients. Diagnostic lung biopsies for repiratory failure have an inherent poor outcome and this continues to be reflected in patients with underlying HIV disease.

CLINICAL IMPLICATIONS:  Thoracic surgery can be performed with adequate results in patients with HIV and AIDS.

DISCLOSURE:  M. Margolis, None.

Wednesday, October 27, 2004

12:30 PM - 2:00 PM




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