title: A 10 years audit of cardiothoracic referrals from a pulmonology service in a developing country: impact of patient human immunodeficiency virus status.
abstract: BACKGROUND
  There are few studies that have documented the clinical presentation, complication rate and outcome of cardiothoracic referrals from a Pulmonology Service, particularly in developing countries. Furthermore, the impact of human immunodeficiency virus (HIV) status on such referrals and their outcomes is not well documented.
  
  
  METHODS
  This was a retrospective audit of combined pulmonologist/cardiothoracic consultations, undertaken among the tertiary academic hospitals attached to the University of the Witwatersrand, Johannesburg, South Africa, over a 10 years period (2001-2010) in order to document the clinical features of these referrals and to determine any impact of HIV status on trends in disease presentations, complications and outcome.
  
  
  RESULTS
  A total of 847 patients were evaluated on whom a variety of surgical procedures was performed, 50.4% being therapeutic, 32.8% diagnostic and 16.9% both therapeutic and diagnostic. HIV status was known in 488 cases. Of these 229 (46.9%) were HIV-seropositive and 259 (53.1%) -seronegative. The main reasons for referral were for infective conditions, including tuberculosis (TB), pleural disease/effusion/empyema, and other bacterial infections, with significantly more of the TB patients being HIV-seropositive (P<0.0001).There was a trend for increasing presentations for TB and pleural conditions, particularly during the last 4-5 years of the audit, coinciding with an increase in the numbers of HIV-positive referrals. HIV status had no impact on the frequency of surgical complications or mortality.
  
  
  CONCLUSIONS
  The audit indicates an increasing referral rate of HIV-seropositive patients to cardiothoracic services in Johannesburg, particularly in association with TB and pleural diseases. However with careful cardiothoracic/pulmonologist evaluation of the cases the frequency of complications and mortality appear to be no different from that of HIV-seronegative cases.
authors.affiliation: 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: George Mwamnemo
authors.initials: GM
authors.lastname: Nyale
authors.affiliation: 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Ronald
authors.initials: R
authors.lastname: Anderson
authors.affiliation: 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Atulkumar Ramanlal
authors.initials: AR
authors.lastname: Patel
authors.affiliation: 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
keywords: Audit; cardiothoracic consultations; human immunodeficiency virus (HIV); pleural disease; tuberculosis (TB)