학술논문
Adjunctive surgery versus medical treatment among patients with cavitary multidrug-resistant tuberculosis.
Document Type
Academic Journal
Author
Vashakidze SA; Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.; The University of Georgia, Tbilisi, Georgia.; Gogishvili SG; Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.; Nikolaishvili KG; Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.; Avaliani ZR; Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.; Chandrakumaran A; Tbilisi State Medical University, Tbilisi, Georgia.; Gogishvili GS; Thoracic Surgery Department, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.; Magee M; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Blumberg HM; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory University, Atlanta, GA, USA.; Kempker RR; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Emory University, Atlanta, GA, USA.
Source
Publisher: Oxford University Press Country of Publication: Germany NLM ID: 8804069 Publication Model: Print Cited Medium: Internet ISSN: 1873-734X (Electronic) Linking ISSN: 10107940 NLM ISO Abbreviation: Eur J Cardiothorac Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: Surgical resection is recommended as adjunctive treatment for multidrug-resistant (MDR) tuberculosis (TB) in certain scenarios; however, data are limited. We sought to evaluate the impact of surgery by comparing TB outcomes among patients with cavitary disease who received medical versus combined medical and surgical treatment.
Methods: A cohort of all patients with cavitary MDR or extensively drug-resistant (XDR) TB treated in Tbilisi, Georgia, between 2008 and 2012. Patients meeting indications for surgery underwent adjunctive resection in addition to medical treatment. We compared TB outcomes (proportions achieving cure/complete) among patients who received adjunctive surgery to those who received medical treatment alone using an adjusted robust Poisson regression.
Results: Among 408 patients, 299 received medical treatment alone and 109 combined medical and surgical treatment. Patients in the non-surgical group were older and had higher rates of tobacco and alcohol use and bilateral disease compared to the surgical group. Patients in the surgical group had higher rates of XDR disease (28% vs 15%). Favourable outcomes were higher among the surgical versus non-surgical group cohort (76% vs 41%). After adjusting for multiple factors, the association between adjunctive resection and favourable outcome remained (adjusted risk ratio 1.6, 95% confidence interval 1.3-2.0); the relationship was also observed in secondary models that excluded patients with bilateral disease (contraindication for surgery) and patients receiving <6 months of treatment. Major postoperative complications occurred among 8 patients (7%) with no postoperative mortality.
Conclusions: Adjunctive surgery is safe and may improve the effectiveness of treatment among select patients with cavitary MDR- and XDR-TB.
(© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Methods: A cohort of all patients with cavitary MDR or extensively drug-resistant (XDR) TB treated in Tbilisi, Georgia, between 2008 and 2012. Patients meeting indications for surgery underwent adjunctive resection in addition to medical treatment. We compared TB outcomes (proportions achieving cure/complete) among patients who received adjunctive surgery to those who received medical treatment alone using an adjusted robust Poisson regression.
Results: Among 408 patients, 299 received medical treatment alone and 109 combined medical and surgical treatment. Patients in the non-surgical group were older and had higher rates of tobacco and alcohol use and bilateral disease compared to the surgical group. Patients in the surgical group had higher rates of XDR disease (28% vs 15%). Favourable outcomes were higher among the surgical versus non-surgical group cohort (76% vs 41%). After adjusting for multiple factors, the association between adjunctive resection and favourable outcome remained (adjusted risk ratio 1.6, 95% confidence interval 1.3-2.0); the relationship was also observed in secondary models that excluded patients with bilateral disease (contraindication for surgery) and patients receiving <6 months of treatment. Major postoperative complications occurred among 8 patients (7%) with no postoperative mortality.
Conclusions: Adjunctive surgery is safe and may improve the effectiveness of treatment among select patients with cavitary MDR- and XDR-TB.
(© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)