Impact of Surgical Valve Intervention on In-Hospital Outcomes in Candida Endocarditis: A 7-Year Analysis

Candida endocarditis (CE) is a rare but highly lethal infection with limited evidence guiding its management. While surgical valve replacement or repair is often recommended, its impact on in-hospital outcomes remains unclear. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify adult admissions with CE. The primary exposure was surgical valve intervention. The primary outcomes were overall and 30-day in-hospital mortality, while the secondary outcomes included length of stay and hospitalization costs. We used multivariable logistic regression, Cox proportional hazards models, and 2 causal inference methods, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), to adjust for potential confounding. We identified 1,280 weighted CE hospitalizations, representing 0.77% of infective endocarditis cases. Among them, 228 patients (17.8%) underwent valve intervention, with a median time to surgery of 9.5 days (IQR = 15 days). Overall, in-hospital mortality was 18.8%, significantly lower in those who underwent surgery (8.3% vs 21.1%; p < 0.001). Valve intervention was associated with reduced mortality across multivariable analysis (AOR 0.28; 95% CI, 0.13-0.55), PSM (OR_PSM 0.31; 95% CI, 0.13-0.66), IPTW (OR_IPTW 0.42; 95% CI, 0.25-0.71), and Cox models (AHR 0.13; 95% CI, 0.07-0.25). However, intervention was also linked to longer hospital stays (β = 1.86; 95% CI, 1.61-2.14) and higher costs (β = 2.10; 95% CI, 1.71-2.61). Surgical valve intervention in patients with CE was associated with significantly lower in-hospital mortality, but at the cost of longer hospital stays and increased resource utilization.