Effectiveness of the surgery in tuberculosis patients at the hospital stage of treatment in the city of Moscow

Based on data from the in-patient phase of treatment of 907 patients with respiratory tuberculosis (TB), discharged in 2016–2018 from the leading clinics in Moscow, the effectiveness of surgical treatment (ST) was evaluated. Two groups were compared: with or without surgery for TB treatment (635 and 272, respectively).
Among the operated patients, there were more young people aged 25–39 years (52.6% vs 35.8%, p < 0.01) and fewer – aged 60 years and older (5.3% vs 15.9%, p < 0.01), a larger proportion of employed (46.8% vs 37.8%, p < 0.05) and non-workers (39.4% vs 28.7%, p <0.01), and a smaller proportion of disabled people and retirees (p < 0.05). Almost all (99%) patients with cavitary lesions of the lung tissue, who were prescribed ST had either tuberculoma (83.3%) or fibro-cavernous tuberculosis (FCTB, 16.2%), while in the other group of patients the proportion of such cases was equal to 20.1%.
The results showed the apparent effectiveness of ST at the time of discharge from the hospital. For all TB patients, as well as for patients with MDR TB, almost 91–93% of the caverns’ closure was achieved by ST in the 2nd month of treatment, while for the rest of the patients by the end of treatment – 51.5%, and in the 2nd month – only 12.7%.
During ST, the conversion of bacterial excretion occurred in all cases (100%) and in 95–98% of cases – already in the 3rd month of treatment. Moreover, without ST, bacteriological conversion occurred in 91.7% courses (p < 0.05), and for patients with tuberculoma or FCTB, respectively, in 85.7% and 71.4% of inpatient treatment courses (p < 0.05). For patients with FCTB without ST in the 3rd month of treatment, bacterial excretion stopped only in 21.4% of patients.
For patients with MDR TB, the considered indicator as a whole  did not give a significant improvement in ST: 100.0% and 89.9%, respectively, but at 2nd months of treatment, the values of the indicator for courses with ST were higher than without it: 84.2 % against 52.2%, p < 0.01.

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