title: Predictors of postoperative complications in HIV-infected children undergoing surgery.
abstract: BACKGROUND
  An increasing number of HIV-infected children require a surgical procedure. The aim of this study was to investigate factors associated with the development of complications in HIV-infected children undergoing surgery.
  
  
  METHODS
  A prospective study of HIV-infected children younger than 60 months undergoing surgery at a tertiary referral pediatric hospital from July 2004 to July 2008 was performed. Children were followed postoperatively for the development of complications, length of stay, and mortality.
  
  
  RESULTS
  Eighty-two HIV-infected children, with a median age of 11.5 months (interquartile range, 6-24 months), were enrolled. Most (68; 82.9%) had World Health Organization stage 3 or 4 HIV disease, 72 (88%) had Centers for Disease Control and Prevention stage 2 or 3 disease, and 60 (73%) were taking highly active antiretroviral therapy. Half (41; 50%) were underweight, 37 (45.1%) underwent emergency surgery, 28 (34.2%) required major surgery, and 40 (48.7%) had surgical site contamination at the time of surgery. The median length of hospital stay was 4 days (interquartile range, 2-14 days), and in-hospital mortality was 6 (7%). Thirty-four (42%) children developed 37 complications. On univariate analysis, malnutrition, HIV stage, or type of surgery was not associated with development of complications. In contrast, young age (6 vs 13.5 months; P = .0004), low hemoglobin (9.6 vs 10.5 g/dL; P = .04), or having a major procedure (14 [42%] vs 9 [18%]; P = .03; relative risk, 2.2 [1.2-4.8]) was associated with complications. On logistic regression, younger age (odds ratio = 4.3; P = .004; 95% confidence interval, 1.6-11.9) and major surgery (odds ratio = 6.8; P = .001; 95% confidence interval, 1.5-31.4) were associated with development of a complication.
  
  
  CONCLUSIONS
  Young age and major surgery were the main predicators of complications in HIV-infected children undergoing surgery.
authors.affiliation: Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town 7700, South Africa. Electronic address: Jonathk2@chw.edu.au.
authors.forename: Jonathan Saul
authors.initials: JS
authors.lastname: Karpelowsky
authors.affiliation: Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town 7700, South Africa.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
authors.affiliation: Department of Pediatric Surgery Erasmus MC-Sophia Children's Hospital, Rotterdam 3000, The Netherlands.
authors.forename: Guido
authors.initials: G
authors.lastname: van Bogerijen
authors.affiliation: Department of Pediatric Surgery Erasmus MC-Sophia Children's Hospital, Rotterdam 3000, The Netherlands.
authors.forename: Nelleke
authors.initials: N
authors.lastname: van der Graaf
authors.affiliation: Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town 7700, South Africa.
authors.forename: Alastair J W
authors.initials: AJW
authors.lastname: Millar
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay / Q000639:trends; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013514:Surgical Procedures, Operative; D015996:Survival Rate / Q000639:trends