Association between preoperative functional status and timing of surgery in tuberculous destroyed lung patients

Tuberculous destroyed lung (TDL) results in severe pulmonary impairment, significantly affecting patients’ functional status and quality of life. The timing of surgical intervention for TDL remains controversial, with debate surrounding the benefits of early versus delayed surgery. This study aimed to evaluate the impact of surgical timing on functional recovery, mortality, morbidity, and cost-effectiveness in TDL patients. Patients with TDL were allocated to early surgery (ESG, ≤ 14 days after initial optimization) or delayed surgery (DSG, after 6–8 weeks of structured preoperative rehabilitation) by treating teams using predefined institutional criteria and informed patient preference (non-randomized; no blinding). The primary outcome was change in 6-minute walk distance at 30 days (Δ6MWT_30d). Secondary outcomes included 30-day complications/mortality, length of stay, readmission, and direct medical costs. Patients in the ESG demonstrated significantly better functional recovery, with a mean 6MWT improvement of 125.4 m compared to 75.8 m in the DSG (p < 0.001). KPS improved by 20 points in the ESG versus 10 points in the DSG (p < 0.001). The ESG also had a significantly shorter hospital stay (8.2 days vs. 13.5 days, p = 0.02) and ICU stay (2.5 days vs. 4.3 days, p = 0.04). Although 30-day mortality was lower in the ESG (4.5%) compared to the DSG (7.8%), this difference was not statistically significant (p = 0.25). The ESG demonstrated a net cost-saving of $7,200 per patient (p < 0.001). Early surgery for TDL patients is associated with superior functional recovery, reduced hospital stays, fewer complications, and lower healthcare costs compared to delayed surgery. These findings support the early surgical intervention approach as the preferred strategy for most TDL patients, particularly those with severe functional impairment. Further studies with long-term follow-up and multi-center validation are warranted.