title: Factors predictive of 30-day postoperative mortality in HIV/AIDS patients in the era of highly active antiretroviral therapy.
abstract: BACKGROUND
  Factors that predict HIV (human immunodeficiency virus)/AIDS patient postoperative mortality have remained poorly defined.
  
  
  OBJECTIVE
  The primary objective of this study was to identify factors predictive of short-term, postoperative mortality in HIV/AIDS patients. The secondary objective of this study was to develop a scoring system that would predict short-term postoperative mortality in HIV/AIDS patients.
  
  
  METHODS
  We retrospectively reviewed all HIV/AIDS patients who underwent surgical procedures in British Columbia, Canada, between April 1995 and March 2002. The primary outcome evaluated was 30-day postoperative mortality. Demographic, clinical, and hospitalization-related data were obtained and utilized to predict outcomes using a logistic regression model.
  
  
  RESULTS
  A total of 2305 procedures were carried out on 1322 patients during the study period. Admissions were classified as urgent/emergent for 1311 procedures (57%) and the overall 30-day postoperative mortality was 9.5% (126 deaths). Urgent/emergent admission, older age, prior surgery, a CD4 cell count of ≤ 50 cells/mm, a hemoglobin level ≤ 120 g/L, and a white blood cell count >11 g/L within 90 days before the surgical procedure was predictive of an increased 30-day postoperative mortality in a multivariate model. Using these variables, we formulated the HIV Surgical Mortality Score (HSMS) to obtain the median-estimated probability of postoperative death.
  
  
  CONCLUSIONS
  For accurate preoperative mortality risk stratification for HIV/AIDS patients, we have found that several clinical and laboratory variables must be evaluated. If appropriately validated, our proposed HSMS could be utilized to estimate the probability of short-term postoperative death among HIV/AIDS patients.
authors.affiliation: Department of Surgery, St Paul's Hospital & Faculty of Medicine, University of British Columbia, Vancouver, Canada. smwiseman@providencehealth.bc.ca
authors.forename: Sam M
authors.initials: SM
authors.lastname: Wiseman
authors.forename: Jamie I
authors.initials: JI
authors.lastname: Forrest
authors.forename: Joe E
authors.initials: JE
authors.lastname: Chan
authors.forename: Wendy
authors.initials: W
authors.lastname: Zhang
authors.forename: Benita
authors.initials: B
authors.lastname: Yip
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Viviane D
authors.initials: VD
authors.lastname: Lima
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis