Occupational Rehabilitation Following Surgery for Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis

Objective: To assess the level of occupational rehabilitation among patients who underwent surgery for multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in the long-term period compared with patients who refused surgery and opted solely for conservative management.

Material and methods: We analyzed long-term outcomes of surgical treatment for destructive pulmonary tuberculosis caused by MDR and XDR Mycobacterium tuberculosis in 976 patients (group 1). Furthermore, we evaluated long-term outcomes of 888 patients (group 2) who had an ineffective main chemotherapy course (regimens IV and V) or relapses after an initially effective chemotherapy course and were managed conservatively because they refused surgery.

Results: One year after the surgery or surgery consultation, the complete clinical response, ie, cavity closure and elimination of bacilli (CV-, MBT-), was achieved in 99.5% of the operated patients, in contrast to only 5.3% among those who refused surgery. At the 5-year mark after the surgery/consultation, we observed the sustained effectiveness in 97.7% of the operated patients compared with only 3.2% among those who refused surgery. During the 12 years of follow-up, tuberculosis-related deaths occurred in 9 operated patients (0.8%) and 643 patients (72.4%) who refused surgery. Furthermore, 78.9% of the patients treated surgically were able to return to work in the long-term period, in contrast to only 2.6% of those who refused surgery.

Conclusions: Our analysis revealed that the complete clinical response one year after the surgery/surgery consultation was 18.8 times more common in the patients who underwent surgery compared with those who refused it. Similarly, the complete clinical response 5 years after the surgery/consultation was 30.5 times higher in the operated patients. Tuberculosis-related deaths during the follow-up were 90.5 times more common among the patients who refused surgery. Furthermore, the 5-year survival rate among the operated patients was 3.3 times higher, and occupational rehabilitation was 30.3 times more common compared with those who refused surgery.

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