European Journal of Cardio-Thoracic Surgery, Vol 6, 279-283, Copyright © 1992 by European Association for Cardio-thoracic Surgery
HIV-1 infection and cardiothoracic surgery: the difference in attitudes between consultants and junior surgeons in the United Kingdom
SS Shah, JC Roxburgh, C Loveday, P Goldstraw and MH Yacoub
Department of Cardiothoracic Surgery, Royal Brompton National Heart and Lung Hospital, London, UK.
A postal survey was carried out inviting the opinions of consultant and
trainee cardiothoracic surgeons on the subject of operating upon patients
who are either HIV-1 antibody positive or suffer from full- blown AIDS. The
questionnaire contained both cardiac and thoracic clinical situations, all
of which under normal circumstances would be managed surgically with low
operative mortality and long median survival. The overall response rate was
72.4%. A significantly greater number of consultants replied compared to
juniors, 80% and 51.6%, respectively (P less than 0.001). In both groups,
surgeons were more likely to operate upon a patient who was HIV-1 antibody
positive than one who had AIDS. There were no significant differences in
the replies of consultants and juniors to the clinical scenarios presented.
However, a greater number of juniors admitted to modifying their surgical
practice in the light of the increasing incidence of HIV-1 infection (P
less than 0.001). Routine preoperative HIV antibody testing was advocated
by 77.8% of consultants and 75% of juniors and this rose to 95.1% and 97%,
respectively, if patients were in the traditionally high risk groups. Four
consultants admitted that they were already performing routine preoperative
HIV antibody screening. This survey emphasized the real concern amongst
cardiothoracic surgeons, irrespective of their grade, about HIV-1 infection
and the need for both education and clear policy guidelines to deal with
this difficult issue.
