Lisa Bearpark1, Ulrik Sartipy2, Anders Franco-Cereceda2, Natalie Glaser3. 1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden. Electronic address: natalie.glaser@ki.se.
Abstract
BACKGROUND: Few studies have analyzed outcomes after surgery for endocarditis in intravenous drug users (IVDUs). The aim of this study was to compare survival after surgery for endocarditis in IVDUs versus non-IVDUs. Secondary outcomes were the rates of reoperation, reinfection, and relapse to drug use. METHODS: This population-based, observational cohort study included all patients who had undergone surgery for endocarditis at Karolinska University Hospital between 2002 and 2019. Patient data were collected from the institutional surgical database and medical charts. We used multivariable Cox regression to analyze associations between intravenous drug use and long-term survival. RESULTS: Of the 510 study patients, 55 were IVDUs (11%) and 455 were not (89%). During a mean follow-up of 5.3 years (maximum, 17.1 years), 30 IVDUs (55%) and 133 non-IVDUs (29%) died. The 30-day mortality was 10.9% and 8.5%, respectively, for IVDUs and non-IVDUs (P = .53). Survival in IVDUs versus non-IVDUs at 1, 5, and 8 years was 76% versus 86%, 49% versus 76%, and 35% versus 68%, respectively (adjusted hazard ratio = 4.12; 95% confidence interval, 2.54-6.68; P < .001). The risk for reoperation was higher in IVDUs (adjusted hazard ratio = 3.47; 95% confidence interval, 1.74-6.89; P < .001). Forty-two IVDUs died or were reinfected (76%) and 49 died or returned to drug use (89%). CONCLUSIONS: After surgery for endocarditis, IVDUs had substantially higher mortality and reoperation rates than did non-IVDUs. However, postoperative survival was comparable between groups, indicating that IVDUs manage surgery well. Prevention of relapse to drug use is of utmost importance in these patients.
BACKGROUND: Few studies have analyzed outcomes after surgery for endocarditis in intravenous drug users (IVDUs). The aim of this study was to compare survival after surgery for endocarditis in IVDUs versus non-IVDUs. Secondary outcomes were the rates of reoperation, reinfection, and relapse to drug use. METHODS: This population-based, observational cohort study included all patients who had undergone surgery for endocarditis at Karolinska University Hospital between 2002 and 2019. Patient data were collected from the institutional surgical database and medical charts. We used multivariable Cox regression to analyze associations between intravenous drug use and long-term survival. RESULTS: Of the 510 study patients, 55 were IVDUs (11%) and 455 were not (89%). During a mean follow-up of 5.3 years (maximum, 17.1 years), 30 IVDUs (55%) and 133 non-IVDUs (29%) died. The 30-day mortality was 10.9% and 8.5%, respectively, for IVDUs and non-IVDUs (P = .53). Survival in IVDUs versus non-IVDUs at 1, 5, and 8 years was 76% versus 86%, 49% versus 76%, and 35% versus 68%, respectively (adjusted hazard ratio = 4.12; 95% confidence interval, 2.54-6.68; P < .001). The risk for reoperation was higher in IVDUs (adjusted hazard ratio = 3.47; 95% confidence interval, 1.74-6.89; P < .001). Forty-two IVDUs died or were reinfected (76%) and 49 died or returned to drug use (89%). CONCLUSIONS: After surgery for endocarditis, IVDUs had substantially higher mortality and reoperation rates than did non-IVDUs. However, postoperative survival was comparable between groups, indicating that IVDUs manage surgery well. Prevention of relapse to drug use is of utmost importance in these patients.
Authors: Ena Hasimbegovic; Marco Russo; Martin Andreas; Paul Werner; Iuliana Coti; Dominik Wiedemann; Alfred Kocher; Günther Laufer; Benedikt S Hofer; Markus Mach Journal: Front Cardiovasc Med Date: 2022-03-25