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.