Association Between Surgical Timing and In-Hospital Mortality in Infective Endocarditis: A Retrospective...

Introduction: Infective endocarditis (IE) remains associated with high mortality, and the optimal timing of surgery in patients without an urgent indication remains uncertain. We evaluated the association between surgical timing and in-hospital mortality. Methods: We retrospectively studied 100 adults with definite IE admitted during 2020-2025 at a tertiary care centre in Bucharest, Romania. The ECHO score incorporated aetiology, blood culture time to positivity, vegetation size, and embolisation or surgical indication. Surgical timing was categorised as study-specific descriptive bins: <7 days, 7-14 days, or >14 days after hospital admission. The primary outcome was in-hospital mortality. Results: Eighty-two patients had a surgical indication (51 non-urgent and 31 urgent), and 60 underwent surgery. In the pooled indicated cohort, crude mortality was 56.0% at <7 days, 23.1% at 7-14 days, 27.3% at >14 days, and 36.4% with no surgery despite indication (p = 0.123). Among patients with a non-urgent indication, mortality was 25.0% (3/12), 25.0% (2/8), 26.7% (4/15), and 25.0% (4/16), respectively, showing no apparent favourable timing interval. Mortality across ECHO score strata 0-1, 2, and 3-4 was non-monotonic (31.8%, 47.6%, and 27.8%); the continuous score showed negligible correlation with mortality (r = -0.05) and an AUC of 0.466 (95% CI 0.353-0.575). Conclusions: Crude mortality differed across timing categories when urgent and non-urgent indications were pooled, whereas mortality was similar across timing categories in the non-urgent subgroup. These timing categories are descriptive and cannot identify a favourable or optimal surgical window or support causal treatment comparisons.