Abstract
Aim. To assess the structure of postoperative complications in patients with Non-tuberculous mycobacterial pulmonary disease (NTM-PD) and the combination of «Tuberculosis — non-tuberculous mycobacterial pulmonary disease» (TB/ NTM-PD), to conduct a statistical analysis of the risk factors for their development in the early and late postoperative periods with the design of a predictive model. Materials and methods. The results of 150 surgeries performed on 145 patients were analyzed. Group 1 (n=44) included patients with an initial diagnosis A16.0 according to ICD-10 (pulmonary tuberculosis (TB) with negative results of bacteriological and histological studies, «TB without etiological verification») and a diagnosis of NTM-PD established during the examination of surgical material. Group 2 (n=64) consisted of patients with NTM-PD diagnosed prior to surgery who underwent surgical treatment for NTM-PD. Group 3 (n=37) included patients with combined pathology «TB/NTM-PD». To study risk factors for bronchopleural complications, 111 patients were selected: 21 cases with postoperative complications (18.9%), and 90 cases without complications (81.1%); all of whom underwent endoscopic examination in the preoperative period. A multifactorial analysis of complications was performed with the development of a predictive model. Results. As a result of the research conducted, it was found that: there were no complications in patients with an initial diagnosis of A 16.0 and a diagnosis of NTM-PD verified during the examination of surgical material (group 1); in patients with preoperative NTM-PD (group 2), only complications of the early postoperative period were recorded — 6.6% (10/150); in patients with «TB/ NTM-PD» (group 3), a total of 7.3% (11/150) cases of postoperative complications were detected (including 3.3% (5/150) cases of late postoperative period). Factors potentially associated with the risk of bronchopleural complications in the postoperative period have been identified: endobronchial pathology (p<0.0001), history of smoking (continues to smoke) (p=0.0009), combined lung resection (p=0.0009), pleural obliteration (p=0.0987). A prognostic model of complications with high predictive ability was constructed with satisfactory compliance indicators: sensitivity (57.14%), specificity (96.67%), AUC-ROC=0.88; R2 (Tjur’s R squared) = 0.3910. Conclusion. The prognostic model based on the identified risk factors (endobronchial pathology (history of smoking (continues to smoke), combined lung resection, pleural obliteration) will allow to predict the development of complications in the postoperative period in 57.14% (sensitivity) of cases and identify patients without a complicated postoperative period in 967% (specificity).