Injection Drug Use and Outcomes After Surgical Intervention for Infective Endocarditis.

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Addiction Medicine

Background:

• Infective endocarditis (IE) surgery in active drug users presents unique treatment challenges.
• Concerns about relapse due to ongoing injection drug use (IDU) influence surgical decisions.
• This study evaluates the impact of active IDU on outcomes following IE surgery.

Purpose of the Study:

• To assess the effect of active injection drug use (IDU) on patient outcomes after surgical intervention for infective endocarditis (IE).
• To identify specific timeframes where active IDU poses the greatest risk for adverse events post-IE surgery.

Main Methods:

• Retrospective analysis of 536 patients surgically treated for IE between 2007 and 2012.
• Identification of 41 patients (8%) with active injection drug use (IDU).
• Primary outcome: death or reoperation for IE, analyzed using multivariable Cox proportional hazards models with time-dependent covariates.

Main Results:

• Patients with active IDU experienced poorer survival free of reoperation.
• A significantly higher hazard of death or reoperation was observed between 90 and 180 days post-surgery (HR, 9.8).
• Among active IDU patients, reoperation and death were equally contributing outcomes, unlike non-IDU patients where reoperation was less common.

Conclusions:

• Active injection drug users (IDU) face a tenfold increased hazard of death or reoperation for infective endocarditis (IE) between 3 and 6 months post-surgery.
• The risk is significantly elevated during this specific postoperative period.
• Outcomes for IE patients with active IDU require careful consideration, particularly in the 3-6 month postoperative window.