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Substance Use and Outcomes of Left-Sided Valve Replacement in Patients With Infective Endocarditis
Katie J Hogan1,2,3, Christopher B Sylvester1,2, Travis J Miles1
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Annals of Thoracic Surgery Short Reports
|January 10, 2025
Summary
Patients undergoing valve surgery for substance use-associated infective endocarditis (SU-IE) are younger but incur higher costs and more readmissions. Improved discharge and readmission prevention strategies are crucial for SU-IE patients.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Public Health
Background:
- Rising substance use (SU) rates necessitate increased left-sided valve surgery for SU-associated infective endocarditis (SU-IE).
- Comparative analysis of outcomes between SU-IE and non-SU-IE patients undergoing valve replacement is critical.
Purpose of the Study:
- To compare outcomes, readmissions, and healthcare costs between patients with SU-IE and those with infective endocarditis (IE) without SU.
- To identify factors influencing in-hospital mortality and readmission rates in IE patients.
Main Methods:
- Utilized the Nationwide Readmissions Database (2016-2018) for a cohort of 10,098 patients undergoing isolated aortic or mitral valve replacement.
- Employed multivariable logistic regression and Kaplan-Meier analysis with Cox proportional hazards models to assess mortality and readmission risks.
Main Results:
- SU-IE patients (21%) were younger (38 vs. 60 years) with fewer comorbidities but had longer hospital stays and higher costs.
- SU-IE patients showed lower in-hospital mortality (3.0% vs. 5.8%) but higher mortality upon readmission (9.6% vs. 4.6%).
- Calendar-year readmissions were significantly higher in SU-IE patients (35.1% vs. 31.0%).
Conclusions:
- Despite younger age and fewer comorbidities, SU-IE patients consume more resources and experience more calendar-year readmissions.
- Effective strategies are needed to optimize discharge planning and reduce readmission rates for SU-IE patients.
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