Hogan Katie J, Sylvester Christopher B, Miles Travis J, Wall Matthew, Rosengart Todd K, Moon Marc R, Coselli Joseph S, Chatterjee Subhasis, Ghanta Ravi K
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg Short Rep. 2024 Jun 20;2(4):759-764. doi: 10.1016/j.atssr.2024.06.002. eCollection 2024 Dec.
Rising rates of substance use (SU) have resulted in an increasing need for left-sided valve surgery for SU-associated infective endocarditis (SU-IE). We compared outcomes, readmissions, and costs between IE patients with and without SU-IE in a national cohort.
Using the Nationwide Readmissions Database (2016-2018), we identified 10,098 patients with infective endocarditis (IE) who underwent isolated aortic or mitral valve replacement. Outcomes within the same calendar year as the index operation were compared between patients with and without SU-IE. Multivariable logistic regressions were used to identify factors associated with in-hospital mortality and 30-day and 90-day readmissions. Kaplan-Meier analysis and a Cox proportional hazards model were used to compare freedom from calendar-year readmission between the groups.
Of the 10,098 patients with IE, 2145 (21%) had SU-IE. Although patients with SU-IE were younger (38 years vs 60 years; < .001) and had fewer comorbidities (Elixhauser score: 12 vs 20; < .001) than patients who did not have SU-IE, patients with SU-IE had longer hospital stays (25 days vs 18 days; < .001) and costlier admissions ($84,949 vs $74,122; < .001). Patients with SU-IE had less in-hospital mortality (3.0% vs 5.8%; < .001) but more often died when readmitted (9.6% vs 4.6%; < .001). Readmissions were similar at 30 days (18.5% vs 18.9%; = .8) and 90 days (31.8% vs 29.3%; = .2), but patients with SU-IE had more calendar-year readmissions (35.1% vs 31.0%; < .018).
Despite their younger age and fewer comorbidities, patients who undergo valve surgery for SU-IE use more resources and more often have calendar-year readmissions than patients with IE but without SU. Strategies are needed to expedite discharge and prevent readmission in patients with SU-IE.
物质使用（SU）率的上升导致因SU相关感染性心内膜炎（SU-IE）而进行左侧瓣膜手术的需求不断增加。我们在一个全国队列中比较了患有和未患有SU-IE的感染性心内膜炎（IE）患者的结局、再入院情况和费用。
利用全国再入院数据库（2016 - 2018年），我们确定了10,098例接受单纯主动脉或二尖瓣置换术的感染性心内膜炎（IE）患者。比较了患有和未患有SU-IE的患者在与初次手术同年的结局。多变量逻辑回归用于确定与住院死亡率以及30天和90天再入院相关的因素。采用Kaplan-Meier分析和Cox比例风险模型比较两组之间的年度再入院自由度。
在10,098例IE患者中，2145例（21%）患有SU-IE。尽管与未患有SU-IE的患者相比，患有SU-IE的患者更年轻（38岁对60岁；P <.001）且合并症更少（埃利克斯豪泽评分：12对20；P <.001），但患有SU-IE的患者住院时间更长（25天对18天；P <.001）且住院费用更高（84,949美元对74,122美元；P <.001）。患有SU-IE的患者住院死亡率较低（3.0%对5.8%；P <.001），但再次入院时死亡的情况更常见（9.6%对4.6%；P <.001）。30天时的再入院情况相似（18.5%对18.9%；P =.8），90天时也相似（31.8%对29.3%；P =.2），但患有SU-IE的患者年度再入院情况更多（35.1%对31.0%；P <.018）。
尽管接受SU-IE瓣膜手术的患者年龄较小且合并症较少，但与患有IE但无SU的患者相比，他们使用的资源更多，且年度再入院的情况更常见。需要采取策略来加快患有SU-IE患者的出院速度并预防再入院。
