Surgical Management of Pulmonary Tuberculosis Complications: A Retrospective Study.

Abstract

Background

Pulmonary tuberculosis remains a major public health problem, particularly in developing countries. Although ant tuberculous chemotherapy is the cornerstone of treatment, surgery still plays an important role in selected patients who develop complications such as massive hemoptysis, destroyed lung, bronchiectasis, empyema, Broncho pleural fistula, or persistent cavitary disease. Evaluating the surgical outcomes of these patients is essential to improve perioperative care and reduce postoperative morbidity and mortality.

Objectives

To assess the indications, postoperative complications, and outcomes of surgical management in patients with pulmonary tuberculosis complications and to determine their impact on hospital stay, intensive care admission, and mortality.

Methodology

This retrospective descriptive study was conducted at Department of Thoracic Surgery Unit, Lady Reading Hospital Medical Teaching Institution, Peshawar from jan 2018 to jan 2019. A total of 100 patients who underwent surgery for complications of pulmonary tuberculosis during the study period were included. Demographic characteristics, clinical presentation, indication for surgery, type of surgical procedure, postoperative complications, hospital stay, ICU admission, and mortality were recorded using a structured data collection form. Data were analyzed using SPSS version 24. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Statistical significance was set at p < 0.05.

Results

A total of 100 patients were included in the study. The mean age of the patients was 41.8 ± 12.6 years, and males constituted 62% of the study population. The most common indications for surgery were massive or recurrent hemoptysis (28%), destroyed lung (24%), bronchiectatic sequelae (18%), tuberculous empyema (16%), and bronchopleural fistula (14%). Lobectomy was the most frequently performed procedure, followed by pneumonectomy and decortication. Postoperative complications were observed in 31% of patients. The most common complications were prolonged air leak (10%), wound infection (7%), postoperative empyema (6%), and bronchopleural fistula (4%). Patients who developed complications had a significantly longer hospital stay compared with those without complications (12.4 ± 4.8 days vs 7.1 ± 2.9 days, p = 0.01). ICU admission was required in 15% of patients, while overall postoperative mortality was 4%.

Conclusion

Surgery remains an important treatment option in selected patients with complications of pulmonary tuberculosis. Although postoperative morbidity is notable, appropriate patient selection, meticulous surgical technique, and careful perioperative management can result in acceptable outcomes. Early recognition of high-risk patients may reduce complications and improve postoperative recovery.