Department of Surgery, Yale University, New Haven, Connecticut.
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Ann Thorac Surg. 2020 Oct;110(4):1185-1192. doi: 10.1016/j.athoracsur.2020.03.089. Epub 2020 May 6.
The rise in the number of valve operations performed for infective endocarditis (IE) due to drug use is an important manifestation of the opioid epidemic. This study characterized national trends and outcomes of valve surgery for drug use-associated IE (DU-IE).
Adults undergoing valve surgery for active IE in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database between July 2011 and June 2018 were stratified as DU-IE and non-DU-IE. Trends and clinical profiles were analyzed. Early outcomes were assessed. The association of DU-IE with outcomes was analyzed with multivariable regression, adjusting for STS Valve Risk model covariates.
There were 34,905 valve operations performed for IE, of which 33.7% were for DU-IE. DU-IE operations increased 2.7-fold during the study period. There was considerable regional variability in DU-IE operations, ranging from 28% to 58% of all IE surgeries in 2018, with highest rates observed in East South Central and South Atlantic regions. DU-IE patients were younger and had fewer cardiovascular comorbidities. Risk-adjusted major morbidity and in-hospital mortality were significantly higher in the DU-IE group. Redo valve procedures in DU-IE patients were associated with worse outcomes, compared with those receiving a first valve operation.
Operations for DU-IE have increased sharply in the United States during the last several years, exhibiting substantial regional variability. DU-IE patients have unique clinical profiles, and worse risk-adjusted outcomes. This demonstrates the significant impact of the opioid epidemic on endocarditis surgeries and punctuates the urgent need for multidisciplinary regional and national efforts to reverse this trend.
由于药物使用导致的感染性心内膜炎（IE）行瓣膜手术的数量增加是阿片类药物流行的一个重要表现。本研究对药物使用相关 IE（DU-IE）的全国性趋势和瓣膜手术结局进行了特征描述。
在 2011 年 7 月至 2018 年 6 月期间，美国胸外科医师学会（STS）成人心脏手术数据库中接受活跃性 IE 瓣膜手术的成年人被分为 DU-IE 和非 DU-IE 组。分析了趋势和临床特征。评估了早期结局。采用多变量回归分析 DU-IE 与结局的相关性，调整 STS 瓣膜风险模型协变量。
共有 34905 例 IE 行瓣膜手术，其中 33.7%为 DU-IE。在此研究期间，DU-IE 手术增加了 2.7 倍。DU-IE 手术存在相当大的地区差异，2018 年 DU-IE 手术占所有 IE 手术的比例从 28%到 58%不等，在东中南部和大西洋南部地区观察到的比例最高。DU-IE 患者年龄更小，心血管合并症更少。调整风险后，DU-IE 组的主要发病率和住院死亡率明显更高。与首次瓣膜手术相比，DU-IE 患者的再次瓣膜手术与更差的结局相关。
在美国，过去几年 DU-IE 的手术数量急剧增加，且存在明显的地区差异。DU-IE 患者具有独特的临床特征，且调整风险后的结局更差。这表明阿片类药物流行对心内膜炎手术产生了重大影响，并强调了迫切需要多学科区域和全国性努力来扭转这一趋势。
