Impact of adjuvant therapeutic surgery on the health-related quality of life of pulmonary tuberculosis patients

Abstract

This study aimed to determine the health-related quality of life (HRQoL) of patients with pulmonary tuberculosis (TB) and to assess its change after a therapeutic surgical procedure. In this scenario, the purpose was to elucidate and quantify the effect of various demographic, epidemiological, clinical, surgical and psychosocial details on this variable. A prospective cohort of 40 patients undergoing therapeutic surgery for pulmonary TB (Study of Human Tuberculosis Lesions (SH-TBL) cohort) was recruited in Tbilisi, Georgia, between 2016 and 2018. HRQoL was assessed by administering the St George's Respiratory Questionnaire (SGRQ) and a novel psychosocial questionnaire, the BCN-Q, both at baseline and at 6 months post-surgery. A statistically and clinically significant improvement in the SGRQ total score was observed at follow-up, although it did not reach the values found for the healthy population. The differences between time points were statistically significant for the following groups: women, age <40 years, body mass index ≥20 kg·m^-2, nonsmokers, drug-susceptible and drug-resistant participants, both new and relapsed patients, early culture negativisation, cases with a single lesion, either lesions <35 mm or ≥35 mm, and lesion, lobe and lung resections. The analysis of BCN-Q together with the SGRQ showed that several of its items, such as marital status, living conditions, nutrition, employment, external support, certain attitudes towards the healthcare system, emotional burden and sleep troubles, can impact HRQoL. These results highlight the benefit of adjuvant therapeutic surgery for pulmonary TB in selected patients in terms of HRQoL and suggest that a comprehensive approach including demographic, epidemiological, clinical and psychosocial variables may more accurately predict TB evolution and prognosis.

FIGURE 1

St George's Respiratory Questionnaire (SGRQ) score change according to time point. Graphs show the participants’ score for each of the components of the questionnaire (a: symptoms, b: activity and c: impacts), as well as their overall total score (d) at both time-points.

FIGURE 2

St George's Respiratory Questionnaire (SGRQ) total score change according to clinical and demographic characteristics of participants and time point: a) sex, b) age, c) body mass index (BMI) and d) smoking status. Circular and square symbols correspond to data from the first visit and follow-up, respectively.

FIGURE 3

St George's Respiratory Questionnaire (SGRQ) total score change according to tuberculosis and surgery-related information of participants and time point: a) drug susceptibility, b) history of previous treatment, c) time to culture negativisation, d) number and e) size of lesions and f) type of resection. Circular and square symbols correspond to data from the first visit and follow-up, respectively. DS: drug-susceptible; MDR: multidrug resistant; XDR: extensively drug-resistant.

FIGURE 4

St George's Respiratory Questionnaire (SGRQ) total score change according to answers to the BCN-Q and time point. Graphs show the score differences depending on a) family or marital status, b) occupation, c) number of cohabitants, d) family financial support, e) need to take care of somebody, f) job loss due to tuberculosis, g) meat, fish and eggs intake, h) dairy products intake, i) use of traditional medicine, j) sleep troubles, k) emotional burden and l) multidrug resistant (MDR)/extensively drug-resistant (XDR) sequelae. Circular and square symbols correspond to data from the first visit and follow-up, respectively.