Risk factors for postoperative complications in patients with pulmonary tuberculosis.

Abstract

Background: The risk factors associated with postoperative complications following pulmonary resection in individuals with tuberculosis remain incompletely understood.

Methods: We conducted a retrospective analysis of baseline data-including sex, age, BMI, comorbidities, previous COVID-19 status, smoking history, respiratory function, ASA grade, affected lung lobe, and operative factors-in patients who underwent surgical treatment at Wuhan Pulmonary Hospital between January 2018 and September 2022.

Results: This study included 204 patients diagnosed with pulmonary tuberculosis (PTB) who underwent surgery at our hospital between January 2018 and September 2022. Of these, 138 cases (67.6%) were male and the median age was 49 years. Postoperative complications were observed in 63 patients, representing an incidence rate of 30.9% (63/204). The most commonly reported complications were prolonged air leak (PAL; 29 cases), postoperative pleural effusion (PE; 23 cases), post-resectional space (PRS; 27 cases), pneumonia (9 cases), and hemorrhage (5 cases). Multivariate analysis identified male sex (odds ratio [OR]: 2.322, 95% confidence interval [CI] 1.015-5.313, p = 0.046), severe adhesion grade (OR 4.304, 95% CI 1.710-10.830, p = 0.002), and longer operative time (OR 1.007, 95% CI 1.003-1.011; p = 0.001) as significant risk factors for postoperative complications. For PAL specifically, male sex (OR 4.003, 95% CI 1.111-14.421, p = 0.034), severe adhesion grade (OR 3.943, 95% CI 1.313-11.839, p = 0.014), and longer operative time (OR 1.005, 95% CI 1.001-1.009, p = 0.016) were significant risk factors. Significant risk factors for postoperative PE included severe adhesion grade (OR 6.078, 95% CI 1.318-28.026, p = 0.021) and longer operative time (OR 1.005, 95% CI 1.000-1.010, p = 0.043). Blood transfusion (OR 4.493, 95% CI 1.270-15.888, p = 0.020) was identified as a significant risk factor for PRS.

Conclusions: Male gender, severe adhesions, and prolonged operative time were identified as significant risk factors for postoperative complications. Specifically, risk factors for postoperative PAL included male sex, severe adhesions, and longer operative time. Severe adhesions and prolonged operative time were also associated with an increased risk of postoperative PE. Intraoperative blood transfusion emerged as a significant risk factor for PRS. This finding helps us identify problems, improve operations, and reduce potential postoperative complications.