Postoperative morbidity and mortality after pneumonectomy (PE) in pulmonary tuberculosis (TB) patients: a 5-year experience

PE may be the last chance for treatment and surviving in the MDR/EDR TB patients. Patient selection is very important to prevent the postoperative mortality. Aim: We examined whether the clinical practice features correlated with postoperative morbidity and 90-day mortality after PE. Methods: The clinical records of the TB patients undergoing PE from 2013 to 2017 and extended pulmonary function testing were collected. The 90-day postoperative course was retrospectively studied according to clinical characteristics, underlying diseases, type of surgery. We used the Ottawa Thoracic Morbidity & Mortality (TMM) System Classifying Thoracic Surgical Complications. Results: TTM was analysed in 124 patients (right PE n=49, M/F 78/46, mean age 39±10years). The 30-day mortality was 2.4%: female, aged 46, 45pack-years, COPD GOLD3, died due to ARDS, pneumonia; male, aged 60, 21pack-years, GOLD1, died due to pneumonia, pneumothorax; male, aged 47, 18pack-years, GOLD3, died due to acute myocardial infarction, atrial fibrillation. There was no 90-day mortality after PE. Different complications were in 63.7% patients: 7.3% wound, 11.3% cardiovascular, 6.5% gastrointestinal, 4% neurological, 48% pleural, 7.3% pulmonary. Major complications rate (≥IIIA grade) was 33%. In multivariate analysis, older age, pulmonary function, class GOLD were significantly associated with the increased TMM in TB patients. The pulmonary complications were also associated with the blood flow in the removing lung. Conclusions: The overall 90-day mortality after PE in TB patients was 2.4%. The postoperative TMM were connected with age, comorbid COPD, low functional level, blood flow in the removing lung.