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

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.