Surgical outcome of pleuro-pulmonary Tuberculosis complications:A five year retrospective study,Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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Date
2020-10
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Addis Abeba University
Abstract
Background Tuberculosis is one of the top
ten causes of mortality in the world. It is
more concerning for African countries as
most of the young productive age group is
the target of the disease. In the older days
surgery was the main mode of management
for pulmonary tuberculosis. Since the
invention of anti-tuberculosis chemotherapy
the role of surgery has reduced. But due to
the emergence of drug resistant TB and post
TB complications, surgical management is
growing again. The current indications of
surgery for pulmonary tuberculosis are post
TB squelae and drug resistant Tuberculosis.
The commonest post TB complications
demanding surgery are Empyema,
hemoptysis, destroyed lung, bronchiectasis,
fistulas, and tuberculoma. After all medical
evolutions, surgical management of TB is
still one of the challenges for thoracic
surgeons. Here we will see the trends of
surgical interventions and outcome in terms
of post-operative complication in our
hospitals.
Methods – It is a retrospective cross
sectional case study done in Ethiopia, Addis
Ababa University, college of health science,
School of Medicine Tikur Anbessa Hospital,
Department of surgery, cardiothoracic and
vascular surgery unit on patients who
underwent surgery for pathologies
secondary to pulmonary Tuberculosis from
January1, 2015-December31, 2019.
Result – 88 patients were participants of the
study. There were 59 men and 29 women.
Mean age is 33.5, Maximum 65 years and
Minimum 16 years with the range of 21-45.
More than 90% of the patients had
productive cough and 53.4% had
hemoptysis. Eight patients had history of
comorbidity. Only two patients were
smokers. All patients had chest X-ray and
97.7% had CT scan of the chest. Out of the
88 patients 56 of them had pathology on the
left side. 13.4% of patients had anemia up
on presentation. Albumin level was
measured in 43.1% of the patients. Out of
these patients 73.6% had normal albumin
level, 13.1% had mild hypoalbuminemia
10.5% moderate hypoalbuminemia, and
2.5% had severe hypoalbuminemia. Only
20% of the patients were screened for HIV
infection. The mean operation time was-186
min/ (minimum 40 min, Maximum 440min).
Mean total Hospital Stay was 27 days
(minimum 7days, Maximum 86 days). For
57% of the patients Post op hospital stay
was <14 days and 42% had stayed >14
days. The most common indication for
surgery was empyema followed by
Aspergilloma. The most common procedure
performed is decortication followed by
pneumenectomy and wedge resection. We
observed a complication rate of 20% with
mortality rate of 1.1%. The most common
complication detected was atelectasis
followed by BPF and pneumonia.
Conclusion- In general Outcome of surgical
management for pulmonary tuberculosis is
good with relatively low morbidity and
mortality. We recommend offering patients
surgery on the appropriate time when
having proper indication.
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Keywords
Surgery,pleuro-pulmonary Tuberculosis