Do specialist pulmonologists appropriately utilise thoracic surgery for drug-resistant pulmonary tuberculosis? A survey

Abstract

Background Adjuvant lung resection in patients with drug-resistant tuberculosis (DR-TB) not only is cheaper than a 2-month course of drug therapy for multidrug-resistant tuberculosis (MDR-TB) but also, more importantly, has a higher cure rate than medical therapy alone. The cure rate for some MDR-TB patients treated with adjuvant lung resection is about 90%. With the more severe forms of DR-TB, surgical cure rates in selected patients remain high, whereas cure rates decrease when only medical therapy is used. In addition, adjuvant lung resection for DR-TB in selected patients with HIV co-infection does not appear to have a higher complication rate. Objectives To determine whether specialist pulmonologists in South Africa utilise thoracic surgical intervention for DR-TB appropriately. Methods A cross-sectional survey was conducted among pulmonologists of the South African Thoracic Society. The study tool was a predesigned, anonymous questionnaire that included 17 closed-ended questions about the role of cardiothoracic surgery in the management of DR-TB. Results A 50% response rate was achieved. The majority of respondents did not know the indications for adjuvant lung surgery in the setting of DR-TB, but would have altered their referral behaviour had they been aware of these indications. Conclusion Participating pulmonologists’ uncertainty regarding optimal use of adjuvant lung resection for DR-TB suggests the need for local guidelines and education initiatives relevant to the management of these patients. These strategies should include the participation of both the pulmonologist and the cardiothoracic surgeon.

Ignorance is never bliss when it comes to patient care

“…In this edition of the AJTCCM , Alexander and Perumal [2] report on a survey sent out to pulmonologists on their knowledge and practice regarding the role of adjuvant lung resection for drug-resistant tuberculosis (DR-TB). As could have been expected, the response rate was low, at 50%.…”