title: Comparison of in-hospital morbidity and mortality in HIV-infected and uninfected children after surgery.
abstract: OBJECTIVE
  Increasingly HIV-infected children can be expected to require surgery. The aim of this study was to compare the outcome of HIV-infected and HIV-unexposed children undergoing surgery.
  
  
  METHODS
  A prospective study of children less than or equal to 60 months admitted to a tertiary pediatric surgical service from July 2004 to July 2008. Children underwent age-definitive HIV testing and were followed up postoperatively for complications, length of stay and mortality.
  
  
  RESULTS
  Three hundred and twenty-seven children were enrolled: 82 (23 %) HIV-infected and 245 (67 %) were HIV-unexposed. Eighty-four (26 %) children were malnourished, which was higher in the HIV-infected group [41 (50.0 %) vs. 43 (17.5 %), relative risk (RR) 2.9; 95 % confidence interval (CI) 2.0-4.1; p < 0.0001]. Three hundred and twenty-eight surgical procedures were performed. A similar number of major [28 (34.2 %) vs. 64 (26.1 %); p = 0.2] and emergency procedures [37 (45.1 %) vs. 95 (38.8 %); p = 0.34] were performed in each group. HIV-infected children had a higher rate of contamination at surgery [40 (48.7 %) vs. 49 (20 %); RR 2.43 (CI 1.7-3.4); p < 0.0001]. There were more complications in the HIV-infected group [34 (41.5 %) vs. 14 (5.7 %); RR 7.3 (CI 4.1-12.8); p < 0.0001]. The most common complications were surgical site complications 30 (55 %), followed by postoperative infections, 19 (34 %). Infections with drug-resistant organisms occurred more commonly in HIV-infected children [11/19 (58 %) vs. 2/13 (15 %); RR 3.8 (CI 1.3-14.2); p = 0.02]. The median length of hospital stay was longer in the HIV-infected group [4 (IQR 2-14) vs. 2 (IQR 1-4) days; p = 0.0001]. There was a higher mortality amongst the HIV-infected group [6 (7.3 %) vs. 0 (0 %); p < 0.0001].
  
  
  CONCLUSIONS
  HIV-infected children have a higher rate of postoperative complications and mortality compared with HIV-unexposed children.
authors.affiliation: Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. jonathan.karpelowsky@health.nsw.gov.au
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Karpelowsky
authors.forename: Alastair J W
authors.initials: AJ
authors.lastname: Millar
authors.forename: Nelleke
authors.initials: N
authors.lastname: van der Graaf
authors.forename: Guido
authors.initials: G
authors.lastname: van Bogerijen
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D007902:Length of Stay / Q000639:trends; D008297:Male; D009017:Morbidity / Q000639:trends; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D013019:South Africa / Q000453:epidemiology; D013514:Surgical Procedures, Operative; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*