Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.
Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA.
Clin Infect Dis. 2020 Jul 27;71(3):480-487. doi: 10.1093/cid/ciz834.
Injection drug use-associated infective endocarditis (IDU-IE) is rising and valve surgery is frequently indicated. The effect of initiating public outcomes reporting for aortic valve surgery on rates of valve surgery and in-hospital mortality for endocarditis is not known.
For an interrupted time series analysis, we used data from the National Inpatient Sample, a representative sample of United States inpatient hospitalizations, from January 2010 to September 2015. We included individuals aged 18-65 with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of endocarditis. We defined IDU-IE using a validated combination of ICD-9 codes. We used segmented logistic regression to assess for changes in valve replacement and in-hospital mortality rates after the public reporting initiation in January 2013.
We identified 7322 hospitalizations for IDU-IE and 23 997 for non-IDU-IE in the sample, representing 36 452 national IDU-IE admissions and 119 316 non-IDU admissions, respectively. Following the implementation of public reporting in 2013, relative to baseline trends, the odds of valve replacement decreased by 4.0% per quarter (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99), with no difference by IDU status. The odds of an in-patient death decreased by 2.0% per quarter for both IDU-IE and non-IDU-IE cases following reporting (OR 0.98, 95% CI 0.97-0.99).
Initiating public reporting was associated with a significant decrease in valve surgery for all IE cases, regardless of IDU status, and a reduction in-hospital mortality for patients with IE. Patients with IE may have less access to surgery as a consequence of public reporting. To understand how reduced valve surgery impacts overall mortality, future studies should examine the postdischarge mortality rate.
与注射吸毒相关的感染性心内膜炎（IDU-IE）发病率不断上升，常需要进行瓣膜手术。启动主动脉瓣手术公共结局报告对心内膜炎患者瓣膜手术和院内死亡率的影响尚不清楚。
采用美国全国住院患者样本（National Inpatient Sample）进行一项中断时间序列分析，该样本为美国住院患者的代表性样本，时间为 2010 年 1 月至 2015 年 9 月。纳入年龄 18-65 岁、国际疾病分类第 9 版（ICD-9）诊断为心内膜炎的患者。通过 ICD-9 代码的验证性组合定义 IDU-IE。使用分段逻辑回归评估 2013 年 1 月公共报告启动后瓣膜置换和院内死亡率的变化。
在该样本中，我们共确定了 7322 例 IDU-IE 住院和 23997 例非 IDU-IE 住院患者，分别代表了全国 36452 例 IDU-IE 入院和 119316 例非 IDU 入院。在 2013 年实施公共报告后，与基线趋势相比，每季度瓣膜置换的可能性降低了 4.0%（比值比[OR]0.96，95%置信区间[CI]0.93-0.99），IDU 状态无差异。报告后 IDU-IE 和非 IDU-IE 病例的院内死亡风险每季度降低 2.0%（OR 0.98，95%CI0.97-0.99）。
启动公共报告与所有 IE 病例的瓣膜手术显著减少相关，无论 IDU 状态如何，IE 患者的院内死亡率降低。由于公共报告，IE 患者可能获得手术的机会减少。为了了解瓣膜手术减少如何影响整体死亡率，未来的研究应检查出院后的死亡率。
