Risk factors for postoperative complications and tuberculosis relapses: a retrospective study

Objective. The aim of this study was to identify significant risk factors associated with postoperative complications, relapses, and exacerbations of pulmonary tuberculosis, with the intention of elucidating their cumulative effect on the likelihood of adverse outcomes

Materials and methods. An observational retrospective cohort single-center study included patients operated on for destructive pulmonary tuberculosis in the period 2004-2010. Inclusion criteria were the presence of a known long-term outcome of treatment or death in hospital. The exclusion criterion was unknown long-term outcome.. Out of 1338 patients operated in this period, 439 (32.8%) met the inclusion criteria.

Results. 111 complications have developed in 87 (19.8%) patients in the postoperative period. In-hospital mortality (within 30 days after surgery) was observed in 4 cases (0.9%) and was associated with tuberculosis progression in all cases. Relapses have occurred in 114 (26.0%) of 439 patients within 15 years after surgical treatment. 16 main risk factors for postoperative complications and relapses of tuberculosis have been identified; the most significant were the presence of XDR MBT, the palliative nature of surgical treatment, duration of the disease, the presence of cachexia and bacterial excretion at the time of surgery. For each patient, the sum of factors in points was calculated (one factor = 1 point). A significant increase in the likelihood of tuberculosis reactivation (>50%) corresponded to a score >5 points. All cases of hospital mortality were observed in patients with a risk level of 9-10 points, late mortality from tuberculosis  –  7–11 points.

Conclusion: Patients with a risk score for tuberculosis reactivation exceeding 5 points demonstrate unsatisfactory treatment outcomes. This underscores the necessity for a more judicious approach to surgical indications, discouraging palliative interventions, while emphasizing the imperative development of preventative strategies tailored to individual risk level.

1. Елькин А.В., Репин Ю.М., Левашов Ю.Н. Отдаленные результаты хирургического лечения туберкулеза легких в зависимости от массивности бактериовыделения и лекарственной устойчивости возбудителя // Пробл. туберкулеза и болезней легких. – 2003. – № 5. – С. 28-31.

2. Елькин А.В., Репин Ю.М., Левашев Ю.Н. Хирургическое лечение послеоперационных рецидивов туберкулеза легких // Пробл. туберкулеза и болезней легких. – 2004. – № 2. – С. 28-32.

3. Ениленис И.И. Хирургическое лечение деструктивного туберкулеза легких у больных с множественной и широкой лекарственной устойчивостью микобактерий: Дисс. … д-ра мед. наук. – М, 2019. – 254 с.

4. Кариев Т.М., Булкасимов С.П., Сабиров Ш.Ю. Повторные операции при реактивации туберкулеза в остаточной плевральной полости после резекции легких // Туберкулез и болезни легких. – 2010. – № 9. – С. 18-21.

5. Краснов В.А. Хирургическое лечение деструктивных форм рецидивов туберкулеза легких: Дисс. … д-ра мед. наук. – М., 2002. – 242 с.

6. Перельман М.И., Наумов В.Н., Добкин В.Г. Показания к хирургическому лечению больных туберкулезом легких // Пробл. туберкулеза. – 2002. – № 2. – С. 51-55.

7. Репин Ю.М. Тактика хирургического лечения больных лекарственно-устойчивым туберкулезом легких // Грудная и сердечно-сосудистая хирургия. – 2001. – № 1. – С. 46-51.

8. Яблонский П.К., Соколович Е.Г., Аветисян А.О., Васильев И.В. Роль торакальной хирургии в лечении туберкулеза легких (обзор литературы и собственные наблюдения) // Медицинский альянс. – 2014. – № 3. – С. 4-10.

9. Giller D., Giller B., Giller G. et al. Treatment of pulmonary tuberculosis: past and present // Europ. J. Cardio-Thorac. Surg. – 2018. – Vol. 53, № 5. – Р. 967-972. doi: 10.1093/ejcts/ezx447.

10. Perelman M.I. Surgical treatment of pulmonary tuberculosis / Reichman and Hershfield’s Tuberculosis: A comprehensive, international approach. – 3rd ed. – Part A // Lung Biology in Health and Disease. – 2006. – Vol. 219. – Р. 459-481.

11. Pomerantz B.J., Cleveland J.C. Jr., Olson H.K. et al. Pulmonary resection for multi-drug resistant tuberculosis // J. Thorac. Cardiovasc. Surg. – 2001. – Vol. 121, № 3. – P. 448-453.

12. Shiraishi Y., Nakajima Y., Katsuragi N., Kurai M., Takahashi N. Resectional surgery combined with chemotherapy remains the treatment of choice for multidrug-resistant tuberculosis // J. Thorac Cardiovasc. Surg. – 2004. – Vol. 128, № 4. – Р. 523-528.

13. World Health Organization. The role of surgery in the treatment of pulmonary TB and multidrug-and extensively drug-resistant TB. – Geneva, Switzerland: WHO, 2014. http://www.euro.who.int/_data/assets/pdf_file/0005/259691/The-role-of-surgery-in-the-treatment-of-pulmonary-TB-and-multidrug-andextensively-drug-resistant-TB.pdf.