Effect of Publicly Reported Aortic Valve Surgery Outcomes on Valve Surgery in Injection Drug- and Non-Injection...

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Injection drug use-associated infective endocarditis (IDU-IE) is a growing concern requiring valve surgery.
• The impact of public outcomes reporting on aortic valve surgery for endocarditis remains unclear.

Purpose of the Study:

• To evaluate the effect of public reporting on aortic valve surgery rates and in-hospital mortality for infective endocarditis (IE).
• To determine if these effects differ between patients with and without a history of injection drug use.

Main Methods:

• An interrupted time series analysis using the National Inpatient Sample (2010-2015).
• Inclusion of patients aged 18-65 diagnosed with endocarditis, with IDU-IE identified via ICD-9 codes.
• Segmented logistic regression to analyze changes in valve replacement and mortality rates post-public reporting implementation in January 2013.

Main Results:

• Following public reporting, the odds of valve replacement decreased by 4.0% quarterly for all IE patients, irrespective of IDU status.
• In-hospital mortality rates decreased by 2.0% quarterly for both IDU-IE and non-IDU-IE cases.
• No significant difference in the change of valve replacement rates was observed based on IDU status.

Conclusions:

• Public reporting initiation correlated with decreased valve surgery for IE patients and reduced in-hospital mortality.
• Patients with IE may experience reduced surgical access due to public reporting.
• Further research is needed to investigate post-discharge mortality to understand the overall impact of reduced surgery rates.