Human immunodeficiency virus and hepatitis testing and prevalence among surgical patients in an urban university hospital

Weiss, Eric S.; Cornwell, Edward E.; Wang, Theresa; Syin, Dora; Millman, E. Anne; Pronovost, Peter J.; Chang, David; Makary, Martin A.

doi:10.1016/j.amjsurg.2006.07.008

« Previous Next »The American Journal of Surgery
Volume 193, Issue 1 , Pages 55-60, January 2007

Human immunodeficiency virus and hepatitis testing and prevalence among surgical patients in an urban university hospital

Presented at the 91st Annual Clinical Congress of the American College of Surgeons, San Francisco, CA, October 18, 2005

Eric S. Weiss, M.D.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
- Corresponding author. Tel.: +1-410-539-7677; fax: +1-410-522-5048.
Edward E. Cornwell III, M.D., F.A.C.S.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Theresa Wang, B.S.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
Dora Syin, B.S.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
E. Anne Millman, M.S.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Patient Safety and Quality Research Group, Johns Hopkins Medical Institutions, Baltimore, MD, USA
Peter J. Pronovost, M.D., Ph.D.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Patient Safety and Quality Research Group, Johns Hopkins Medical Institutions, Baltimore, MD, USA
David Chang, Ph.D., M.P.H., M.B.A.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
Martin A. Makary, M.D., M.P.H.
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Patient Safety and Quality Research Group, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Received 27 November 2005; received in revised form 22 July 2006 published online 10 November 2006.

Abstract

Background

Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C represent significant public health problems in an urban community. Early diagnosis and treatment of these infections can improve survival and allow for preventive strategies to reduce further transmission within a community. The aim of this study was to evaluate the surgical setting as a potential opportunity for early diagnosis of HIV, hepatitis B, and hepatitis C among trauma and non-trauma patients.

Methods

We performed a retrospective review of patients presenting for surgery over a 10-year period (July 1994 to July 2004) in an urban, university-based general surgical practice that includes all trauma services, as well as emergency department, inpatient, and outpatient surgical consultations. Data collected included diagnosis, operation, age, race, history of intravenous drug abuse, and HIV, hepatitis B, and hepatitis C test results.

Results

Among 2876 patients presenting for surgery, testing for blood-borne pathogens was less likely among trauma patients (21%, 79/380) compared to non-trauma patients (47%, 1183/2496) (P < .001). Among patients tested, the incidence of blood-borne pathogens was similar in the two groups: HIV (26% trauma vs 24% non-trauma, not significant [NS]), hepatitis B (4% trauma vs 3% non-trauma, NS), hepatitis C (33% trauma vs 41% non-trauma, NS), and co-infection with HIV and hepatitis C (18% trauma vs 12% non-trauma, NS). In both groups, blood-borne pathogens were associated with intravenous drug abuse (P < .01).

Conclusion

HIV, hepatitis B, and hepatitis C are common in an urban community among both trauma and non-trauma surgical patients, although testing is less common among trauma patients. Testing of patients during a surgical admission may represent an excellent opportunity for early disease-specific services and preventive interventions.