Preoperative clinical assessment for anaesthesia: The effect of human immunodeficiency virus infection

Abstract

BACKGROUND

HIV infection is common in South Africa. The disease often remains clinically latent, despite the patient having severe immune compromise. Clinical preoperative assessment may result in patients with this severe systemic disease going unnoticed.

OBJECTIVES

We set out to determine the preoperative physical status of HIV-positive patients presenting for anaesthesia, and to compare this with the CD4-count of the patients. We also set out to determine the prevalence of HIV infection in this group of patients as well as in selected subgroups.

METHOD

We selected a sample of 350 adult patients presenting for anaesthesia at Chris Hani Baragwanath Hospital. Patients were interviewed preoperatively and were examined, and in doing so their ASA physical status grading was determined. Blood was sampled, and in those who were confirmed HIV-positive, a CD4-count was checked. Further data were collected in order to determine trends in the characteristics of HIV-positive patients - specifically age, gender, and the type, nature and urgency of surgery.

RESULTS

HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3 or 4 (OR 2.1). HIV-positive patients with CD4-counts above 200 cells.mm-3 were also more likely to be ASA 1 or 2 (OR 3.88). However, within the group of HIV-positive patients with CD4-counts below 200 cells.mm-3 significantly more patients were classified as ASA 1 or 2 than ASA 3 or 4 (p<0.0001). Three patients with CD4-counts below 50 cells.mm-3 were classified as ASA 1 or 2. The prevalence of HIV infection was 29.4%. Within the various subgroups, the groups with higher disease prevalence rates were females, patients presenting for obstetric surgery, and the younger age groups. The highest prevalence of HIV infection was found in patients aged 30-39 years (43.0%) and the lowest prevalence was found in patients aged 60 years or older (7.7%).

CONCLUSIONS

Routine clinical preoperative assessment in patients from a population with a high HIV prevalence rate may result in asymptomatic, severe immune compromise being missed in a significant number of patients. Further study into the postoperative outcomes of these patients is warranted.