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The Impact of Addictions Management Following Cardiac Surgery on People Who Inject Drugs and Have Infective
Alison Greene1, Navjot Sandila2, Anthony Pryor3
1Division of Cardiac Surgery, Department of Surgery, Queen Elizabeth II (QEII) Health Sciences Centre, Halifax, Nova Scotia, Canada.
Insights
Managing addiction in patients who inject drugs after cardiac surgery did not significantly alter reinfection readmission rates. Female patients showed a higher risk of reinfection, highlighting a need for targeted interventions.
Area of Science:
- Cardiology
- Infectious Diseases
- Addiction Medicine
- Public Health
Background:
- Patients who inject drugs and undergo cardiac surgery face high mortality risks, particularly from reinfection.
- A significant gap exists in addressing addiction management during the index hospitalization for cardiac surgery in this population.
- Understanding the impact of addiction management on reinfection rates is crucial for improving patient outcomes.
Purpose of the Study:
- To determine if addiction management interventions influence readmission rates for reinfection in patients who inject drugs post-cardiac surgery.
- To analyze the utilization of addiction-related consultations and treatments in this patient cohort.
- To identify factors associated with reinfection readmission.
Main Methods:
- Retrospective chart review and analysis of patients who underwent cardiac surgery for infective endocarditis due to injection drug use.
- Assessment of addiction management components: addictions medicine consultation, social work consultation, medication- and/or opioid-assisted treatment, and community follow-up.
- Multivariate logistic regression to analyze the association between interventions and reinfection readmission.
Main Results:
- Of 41 patients, 43.2% received addictions medicine consultation, 67.6% social work, 40.5% medication/opioid-assisted treatment, and 56.8% community follow-up.
- Overall mortality was 21.6%, with 56.8% readmitted for reinfection.
- Intervention was associated with a non-significant 1.6 times higher likelihood of reinfection readmission (OR 1.65, P=0.5736). Female gender was a significant predictor of reinfection (OR 9.95, P=0.021).
Conclusions:
- A nonstandardized approach to addiction consultation and management was observed.
- While patients receiving interventions showed a trend towards higher readmission for reinfection, the difference was not statistically significant.
- Formalized addiction consultation services should be promoted for high-risk patient populations to potentially improve outcomes.
Background:
Managing reinfection in patients who inject drugs and have undergone cardiac surgery could reduce mortality. A significant gap exists in the management of addiction in this population and it is rarely addressed during index hospitalization for surgical intervention. This study sought to determine if management of addiction changed rates of readmission for reinfection.
Methods:
This study was a retrospective chart review and analysis. Patients who underwent cardiac surgery for infective endocarditis due to injection drug use underwent a full chart review to determine if they received management of their addiction (addictions medicine consultation, social work consultation, medication- and/or opioid-assisted treatment, and community follow-up) following their surgical intervention.
Results:
A total of 41 patients were identified who met the inclusion criteria. For addictions management, 43.2% of patients received an addictions medicine consultation, 67.6% received a social work consultation, 40.5% received medication- and/or opioid-assisted treatment, and 56.8% received community follow-up. Overall mortality of these patients was 21.6%, and 56.8% of patients were readmitted with reinfection. Multivariate logistic regression showed that patients who received intervention were 1.6 times more likely to be readmitted with reinfection (odds ratio 1.65, 95% confidence interval 0.29-9.41, P = 0.5736). Female patients had a significantly higher odds of reinfection, when adjusted for gender (odds ratio 9.95, 95% confidence interval 1.42-69.72, P = 0.021).
Conclusions:
We demonstrated a nonstandardized approach to consultation and varying approaches to management of addiction. Patients who received intervention for addiction were more likely to be readmitted for reinfection, but this difference was not significant. Future efforts can include promotion of formalized addictions consultation services for high-risk patients.
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